Randomized Controlled Trial of a Mobile Health Intervention to Promote Retention and Adherence to Preexposure Prophylaxis Among Young People at Risk for Human Immunodeficiency Virus: The EPIC Study

Liu, Albert Y.; Vittinghoff, Eric; Felten, Patricia von; Amico, K Rivet; Anderson, Peter L.; Lester, Richard; Andrew, Erin; Estes, Ixchell; Serrano, Pedro A.; Brothers, Jennifer; Buchbinder, Susan; Hosek, Sybil; Fuchs, Jonathan

doi:10.1093/cid/ciy810

Cited by 119 publications

(155 citation statements)

References 34 publications

(32 reference statements)

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“…However, alternative delivery systems will also need to provide support for PrEP users who are struggling with adherence or could benefit from additional services such as substance use treatment. For instance, mobile health strategies such as asynchronous two‐way messaging could allow large PrEP programmes to efficiently target support to individuals who request help [8]. Even within a traditional delivery setting, over half of those interviewed who stopped PrEP did not discuss it with their provider.…”

Section: Discussionmentioning

confidence: 99%

“…Pre‐exposure prophylaxis (PrEP) is a highly effective biomedical prevention strategy when taken during periods of HIV risk [1,2]. Although PrEP persistence (sustained PrEP use over time) was high among PrEP users in clinical trials and early demonstration projects [2‐4], it has been variable among later PrEP adopters and in real‐world evaluations, with 15 to 62% of users discontinuing PrEP by six months [5‐14]. Prevention‐effective adherence is a concept which describes the importance of using PrEP during periods of HIV risk, as compared to antiretroviral therapy, for which lifelong adherence is required [15].…”

Section: Introductionmentioning

confidence: 99%

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Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

et al. 2020

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Introduction Pre‐exposure prophylaxis (PrEP) is highly effective, although PrEP adherence and persistence has been variable during real world implementation. Little is known about missed opportunities to enhance PrEP adherence among individuals who later HIV seroconverted after using PrEP. The goal of this analysis was to identify all HIV infections among individuals who had accessed PrEP in an integrated health system in San Francisco, and to identify potentially intervenable factors that could have prevented HIV infection through in‐depth interviews with people who HIV seroconverted after using PrEP. Methods We identified individuals who initiated PrEP in an integrated safety‐net public health system and performed in‐depth chart review to determine person‐time on and after stopping PrEP over six years. We identified all PrEP seroconversions using the Centers for Disease Control and Prevention’s Enhanced HIV/AIDS Reporting System and then calculated HIV incidence while using PrEP and during gaps in use. We then performed in‐depth interviews with those who seroconverted. Results Overall, 986 initiated PrEP across the San Francisco Department of Public Health from July 2012 to November 2018. Data were gathered from 895 person‐years on PrEP and 953 after stopping PrEP. The HIV incidence was 7.5‐fold higher after stopping PrEP compared to while on PrEP (95% CI 1 to 336). Of the eight individuals who HIV seroconverted; only one was taking PrEP at the time of seroconversion but was using on‐demand PrEP inconsistently. All eight agreed to qualitative interviews. Major barriers to PrEP persistence included substance use, mental health and housing loss; difficulty accessing PrEP due to cost, insurance, and the cost and time of medical visits; difficulty weighing PrEP’s benefit versus self‐perceived risk; and entering a primary partnership. The individual who developed HIV using on‐demand PrEP reported confusion about the dosing regimen and which sexual encounters required accompanying PrEP dosing. Conclusions HIV incidence during gaps in PrEP use was nearly eight‐fold higher than while on PrEP in this large cohort in San Francisco. Many individuals who stop PrEP remain at risk of HIV, and participants reported that proactive outreach could potentially have prevented HIV infections. Individuals using non‐daily PrEP may require additional education and support in the United States.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

et al. 2020

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“…Six articles had an exclusive focus on MSM as a target group [39][40][41][42][43][44]. Five articles had a focus on the combination of MSM and TGW [45][46][47][48][49].…”

Section: Key Population-speci C Modelsmentioning

confidence: 99%

“…Delivery channels were understood as platforms or media that were used to deliver PrEP services to the people. In most of the articles, PrEP care was provided through a 'traditional' face-to-face setting, meaning PrEP clients attended in-person to a service provider in a given physical setting [22][23][24][25][26][27][28][29][31][32][33][34][35][36][37][38]40,44,47,[49][50][51][52][53][54].…”

Section: Traditional Delivery Modelsmentioning

confidence: 99%

The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review

Vanhamel

Rotsaert

Reyniers

et al. 2020

Preprint

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Background: Strengthening HIV prevention is imperative given the continued high HIV incidence worldwide. The introduction of oral PrEP as a new biomedical HIV prevention tool can be a potential game changer because of its high clinical efficacy and the feasibility of its provision to different key populations. Documenting the existing experience with PrEP service delivery in a variety of real-world settings will inform how its uptake and usage can be maximised. Methods: We conducted a scoping review using the five-step framework provided by Arksey and O’Malley. We systematically searched the existing peer-reviewed international and grey literature describing the implementation of real-world PrEP service delivery models reporting on four key components: the target population of PrEP services, the setting where PrEP was delivered, PrEP providers’ professionalisation and PrEP delivery channels. We restricted our search to English language articles. No geographical or time restrictions were set.Results: This review included 33 articles for charting and analysing of the results. The identified service delivery models showed that PrEP services mainly targeted people at high risk of HIV acquisition, with some models targeting specific key populations, mainly men who have sex with men. PrEP was often delivered centralised and in a clinical or hospital setting. Yet also community-based as well as home-based PrEP delivery models were reported. Providers of PrEP were mainly clinically trained health professionals, but in some rare cases community workers and lay providers also delivered PrEP. In general, in-person visits were used to deliver PrEP. More innovative digital options using mHealth and telemedicine approaches to deliver specific parts of PrEP services are currently being applied in a minority of the service delivery models in mainly high-resource settings.Conclusions: A range of possible combinations was found between all four components of PrEP service delivery models. This reflects differentiation of care according to different contextual settings. More research is needed on how integration of services in these contexts could be expanded and optimised to respond to key populations with unmet HIV prevention needs in different settings.

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“…A mobile platform targeted at improving HIV and SRH knowledge among AYA in sub-Saharan Africa could provide much-needed education, even to those not currently accessing HIV services, particularly in countries like Kenya were mobile phone use is very high. This provides a means of reaching AYA who may be in or out of school, who are seeking high-quality education about HIV and SRH.Several studies have evaluated a range of mHealth interventions and their effect on HIV testing, ART adherence, and HIV prevention (31)(32)(33)(34)(35). While what we present here is not a research study and we are not able to report on the effect of app use on AYA care outcomes, such as HIV and STI testing,…”

mentioning

confidence: 99%

HIVFactSheet: A mobile application designed and implemented by youth peer mentors to facilitate HIV and reproductive health care among adolescents and young adults

Apondi¹,

Bakari²,

Kwendo³

et al. 2020

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Background:Adolescents and young adults in sub-Saharan Africa face complex challenges in accessing HIV testing, HIV care, and sexual and reproductive health services. We describe and characterize the uptake of a unique mHealth intervention that was designed, led, and implemented by youth peer mentors (YPM) in the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya.Methods: YPM developed a mobile application to address the unmet needs that they identified in youth education around HIV testing, HIV care, and sexual and reproductive health. The application incorporates comprehensive educational materials and information about health services in Kenya. Users can set up reminders for clinic appointments and may call, text, or email a YPM for assistance accessing care or to ask care-related questions. The application has been promoted at AMPATH clinics and on social media. We describe its implementation in this setting.Results: Since launching the application in December 2017, as of April 2019 the application was downloaded 5,800 times, with 4,953 current users. Downloads primarily originated in Kenya (74%) and other African countries, but also globally. Texts to YPM through the application included questions about a broad range of topics on HIV testing, prevention, and care; reproductive and sexual health; substance abuse and addiction; and navigating health care. YPM contacted through the app provided individualized counseling and referred 183 users to health services. YPM utilize the application in large- and small-group and individual peer education sessions, and in trainings for healthcare workers, teachers and new YPM.Conclusions: Adolescents and young adults should be empowered to lead interventions to address the challenges that they face in navigating care. A unique mobile application intervention spearheaded by YPM providing access to comprehensive health education and individualized counseling and referral has great potential to facilitate HIV and sexual and reproductive health care for young people.

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Randomized Controlled Trial of a Mobile Health Intervention to Promote Retention and Adherence to Preexposure Prophylaxis Among Young People at Risk for Human Immunodeficiency Virus: The EPIC Study

Abstract: An interactive text-messaging intervention had high acceptability and significantly increased study-visit retention and PrEP adherence among young individuals at risk for HIV acquisition.

Cited by 119 publications

References 34 publications

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review

HIVFactSheet: A mobile application designed and implemented by youth peer mentors to facilitate HIV and reproductive health care among adolescents and young adults

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