Text Message Intervention Improves PrEP Adherence Among MSM at Risk for HIV

An interactive text messaging intervention increased pre-exposure prophylaxis (PrEP) adherence in a study of young people at risk for HIV, highlighting an effective intervention for improving usage in key populations.

Interventions for improving both access and adherence to PrEP is critical for preventing new HIV infections. While uptake of the treatment has skyrocketed since the approval of Gilead’s Truvada for HIV prevention in 2012, disparities in usage persist and adherence levels remain inadequate, underscoring the need for interventions.

“Young men who have sex with men (YMSM) are among the highest at-risk for HIV in the US, with black and Latino MSM accounting for over three-quarters of new infections among young YMSM in 2015,” wrote the researchers of the study. “Furthermore, youth are the least likely to initiative PrEP, and discontinuation rates are high.”

Read about barriers to PrEP usage.

In the study of more than 121 YMSM, those who used the support intervention, PrEPmate, were more likely to attend study visits and have higher rates of adherence to the treatment. The study randomized participants 2:1 to receive PrEPmate intervention versus standard of care for 9 months between April 2015 and March 2016. Standard of care included a risk assessment, PrEP education, and brief adherence and risk-reduction counseling; clinical evaluation, medical management, and PrEP dispensation by a clinician; and access to a pager to contact a clinician as needed.

The 2-way PrEPmate intervention included daily pill-taking reminder text messages sent at a customized time consisting of fun facts and trivia for 2 weeks following initiation of PrEP, with the option of continuing reminders throughout the study, as well as weekly check in messages asking how the treatment was going. The intervention also included online components, such as a website providing access to information about PrEP, videos and testimonials of peers taking PrEP, and an online support forum.

At 1 month, 86% of participants showed tenofovir diphosphate (TVF-DP) levels consistent with 4 or more doses per week. However, that percentage dropped to 50% at 9 months. As time progressed, missed visits increased from 7% at 1 month to more than a quarter (27%) at 9 months.

Those using the PrEPmate intervention were 15% more likely to attend the monthly visits (86% vs 71%). They were also 15% more likely to have appropriate TVF-DP levels (72% vs 57%). The researchers noted that among PrEPmate users, retention and adherence did not vary significantly by age, race/ethnicity, education, or insurance.

“Despite higher adherence in the intervention arm, only 57% of PrEPmate arm participants had protective TFV-DP levels at week 36, suggesting additional efforts may be required to sustain long-term adherence,” they added.

Attitudes toward PrEPmate were favorable, with 88% of those using the intervention reporting that it was very or somewhat helpful, 83% wanting to continue using the intervention after the study, and 92% saying they would recommend it to others.

Looking forward, the researchers indicated that future implementation research is needed to determine the impact of PrEPmate when implemented in a more diverse geographic and clinic settings, as well as in youth under age 18 as the FDA has recently expanded PrEP’s indication to include the patient population.

Reference:

Liu A, Vittinghoff E, von Felton E, et al. Randomized controlled trial of a mobile health intervention to promote retention and adherence to pre-exposure prophylaxis among young people at risk for human immunodeficiency virus: the EPIC study. [published online September 15, 2018]. Clin Infect Dis. doi: https://doi.org/10.1093/cid/ciy810.