Mobile App Results in Increased HIV PrEP Adherence Among Users in Thailand

When using a mobile phone app that supports HIV pre-exposure prophylaxis (PrEP) adherence, individuals who used the app more frequently were found to have higher rates of PrEP adherence, according to a study published in Journal of Medical Internet Research.

While the authors said the findings were not statistically significant and may not be indicative of long-term adherence due to the short study duration, they suggested app use can help establish habits in taking daily PrEP.

The study was conducted in Thailand between March 2018 and June 2019 with 200 participants, including Thai young men who have sex with men (YMSM) and young transgender women (YTGW). The median (IQR) age among participants was 18 (17-19), and most (74%) participants were YMSM.

In the randomized controlled trial, 100 participants received 6 months of youth-friendly PrEP services (YFS), which included monthly engagement with site staff via in-person visit or telephone call, and the ability to contact staff and counselors outside of scheduled visits. The other 100 participants were randomized to receive YFS in addition to use of the Project Raincoat PrEP adherence support app (YFS+APP).

Features of the mobile app were based on what the authors referred to as the 3Rs: risk assessment, reminders, and rewards.

PrEP adherence was evaluated at months 3 and 6 using dried blood spots containing tenofovir diphosphate, and patient perspectives on the app were collected through exit interviews and were generally positive regarding the app’s ease of use.

“App design allowing ease of utility clearly influenced how likely participants would use the app,” the authors wrote. “This observation is in keeping with previous studies that found simple interfaces may reduce the time participants need to spend on the app and therefore improve retention.”

Interviewees also expressed that the risk assessment function was deemed the most useful feature in the app, and suggested changes to the rewards aspect and overall aesthetic of the app.

Among the YFS+APP group, 87% of participants used the app and completed the weekly HIV acquisition risk assessments. Additionally, 22% were considered frequent app users, defined as logging in and completing an assessment at least 10 times during the 6-month period.

Overall, the median (IQR) duration between first and last login was 3.5 (1.6-5.6) months, with a median login and risk assessment (LRA) frequency of 6 LRAs.

The authors also found variations in LRA frequency between YMSM and YTGW participants. The study showed YMSM were 9.3 times more likely to be deemed frequent app users compared with YTGW (95% CI, 1.2-74.3; P = .04).

Frequency of app use was shown to be linked to PrEP adherence, though it was not statistically significant. At both months 3 and 6, frequent users had higher proportions of adherence between 12% and 16%, compared with infrequent users with LRAs of less than 10 and participants in the YFS group.

The authors emphasized the need for additional research focusing on the specific mechanisms of apps that influence health behaviors, especially in low– and middle-income areas with limited staff.

“MHealth development and implementation will ultimately benefit health access and delivery for HIV prevention services beyond its current apps in the current COVID-19 pandemic,” the authors concluded.

Reference

Kawichai S, Songtaweesin WN, Wongharn P, et al. A mobile phone app to support adherence to daily HIV pre-exposure prophylaxis engagement among young men who have sex with men and transgender women aged 15 to 19 years in Thailand: pilot randomized controlled trial. JMIR Mhealth Uhealth. 2022;10(4):e25561. doi:10.2196/25561