SMS Reminders Improved PrEP Adherence in Youth at Risk for HIV

Albert Liu, MD, MPH

Youth at risk for HIV showed increased adherence to pre-exposure prophylaxis (PrEP) when they received reminders and support through an interactive text-messaging service, new research shows.

Young men who took part in a study of the PrEPmate intervention were also more likely to attend visits concerning HIV compared to those who received the typical standard of care for PrEP.

“PrEPmate was found to be highly acceptable, with 88% of participants in the PrEPmate arm reporting it was very/somewhat helpful,” investigators wrote. Further, 83% of the PrEPmate group wanted to continue using the program after the study ended and 92% said they would recommend it to others.

“These results demonstrate that a highly scalable mobile health intervention can increase both retention and adherence to PrEP among young MSM when evaluated in a randomized clinical trial,” corresponding author Albert Liu, MD, MPH, told MD Magazine®.

“Clinicians and PrEP programs can consider using a text-messaging approach similar to PrEPmate as a strategy to support youth taking PrEP,” said Liu, Clinical Research Director, Bridge HIV, San Francisco Department of Public Health.

Young men who have sex with men (YMSM) are among the most vulnerable to HIV infection. They are also the least likely to adhere to a PrEP regimen to reduce the chance of contracting HIV. “There is a critical need to develop new tools to support PrEP use among youth,” Liu said.

To reach this group, PrEPmate was developed to combine the ubiquity of cellphones with mobile health technology. Mobile health services have demonstrated enormous potential to support HIV prevention and PrEP adherence in youth, Liu and colleagues wrote.

PrEPmate uses SMS messaging and interactive online content to boost adherence to the medication regimen. The program supplies daily pill-taking prompts, weekly check-in messages, and reminders about clinic visits. An accompanying website offers access to HIV information, and participants can receive extra support if they request it.

The typical standard of care for PrEP delivery, in contrast, includes a risk assessment, PrEP education, and brief adherence and risk-reduction counseling by a health educator. There was also clinical evaluation, medical management, and PrEP dispensation by a study clinician. Participants watched a video that explains how PrEP works. They received access to a pager to reach a clinician and received reminders for clinic visits via phone calls.

To evaluate PrEPmate versus standard of care, the team recruited participants from a Chicago public health clinic that focuses on HIV prevention, care, and research.

They chose English-speaking MSM 18-29 years-old who were HIV-negative, met criteria for being at risk for HIV, and were medically eligible to take PrEP. Of 134 potential participants, 121 were enrolled from April 2015 to March 2016.

The group was randomized 2:1 to receive PrEPmate or standard of care. All participants were provided 9 months of free access to the antiretroviral combination tenofovir-disoproxil-fumarate/emtricitabine (TDF/FTC) PrEP. Follow-up visits were conducted at weeks 4, 12, 24, and 36.

The researchers considered participants’ study-visit completion rate and their adherence to the PrEPmate regimen. PrEPmate participants scored higher in both categories. This group completed 86% of visits compared to 71% for standard of care participants. PrEPmate participants also reported a larger proportion of visits in which levels of tenofovir diphosphate (TFV-DP) indicated adherence to PrEP.

“The proportion of visits in which participants were retained and had protective TFV-DP levels were 15% higher in the intervention vs. control arms at week 36,” the researchers wrote.

Participants’ use of PrEPmate’s features varied. All continued weekly check-ins until the end of the study; 65% continued daily SMS reminders after 2 weeks, 58% accessed information on the website, 44% watched at least 1 video, and 35% participated in a forum.

Overall, participants found the daily and weekly text messages the most helpful. “These features helped to foster communication and connection between the patient and provider, in addition to providing a daily reminder to take PrEP,” Liu said.

The authors noted that it may be difficult to generalize the results because the study was conducted at a single “safety-net” clinical site in Chicago with just 121 participants. In addition, the PrEP medication was provided free-of-charge.

“Future research is needed to assess the impact of PrEPmate across a range of different geographic and clinical settings, and to identify factors which may influence the successful implementation and scale-up of PrEPmate,” Liu said. “It will also be important to evaluate the cost-effectiveness of PrEPmate.”

Liu and colleagues are currently evaluating PrEPmate in transgender individuals. Next, they plan several pilot studies in collaboration with US health departments to evaluate PrEPmate in different public health settings. Future research may test the program in those under 18 and in older age groups, Liu said.

The study, “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,” was published in Clinical Infectious Diseases.