A Mobile Health Strategy to Support Adherence to Antiretroviral Preexposure Prophylaxis

Abstract

Preexposure prophylaxis is a highly protective HIV prevention strategy, yet nonadherence can significantly reduce its effectiveness. We conducted a mixed methods evaluation of a mobile health intervention (iText) that utilized weekly bidirectional text or e-mail support messages to encourage preexposure prophylaxis (PrEP) adherence among participants in the multi-site iPrEx open-label extension study. A convenience sample of PrEP users from the San Francisco and Chicago sites participated in a 12-week pilot study. Fifty-six men who have sex with men were enrolled; a quarter of them were less than 30 years of age, 13% were black/African American, 11% were Latino, and most (88%) completed some college. Two-thirds opted for text message delivery. Of the 667 messages sent, only 1 individual requested support; initial nonresponse was observed in 22% and was higher among e-mail compared to text message recipients. Poststudy, a majority of participants would recommend the intervention to others, especially during PrEP initiation. Moreover, younger participants and men of color were more likely to report that they would use the iText strategy if it were available to them. Several participants commented that while they were aware that the messages were automated, they felt supported and encouraged that “someone was always there.” Study staff reported that the intervention is feasible to administer and can be incorporated readily into clinic flow. A pre–post intervention regression discontinuity analysis using clinic-based pill counts showed a 50% reduction in missed doses [95% confidence interval (CI) 16–71; p = 0.008] and 77% (95% CI 33–92; p = 0.007) when comparing pill counts at quarterly visits just before and after iText enrollment. A mobile health intervention using weekly bidirectional messaging was highly acceptable and demonstrated promising effects on PrEP adherence warranting further evaluation for efficacy in a randomized controlled trial.

A Systematic Review of eHealth Interventions Addressing HIV/STI Prevention Among Men Who Have Sex With Men

“…Sexual risk behaviors were the most common primary outcomes (n = 32 studies), following by HIV/STI testing and self-testing (n = 18 studies) and HIV/STI disclosure, stigma, self-esteem, and internalized homonegativity (n = 9 studies). Several studies focused on HIV/STI prevention knowledge and attitudes [47,56,67,86,87], HIV disclosure [60,62,79,[87][88][89], gonorrhea and chlamydial infection and treatment [90], or pre-exposure prophylaxis uptake [57,91] and adherence [92,93]. Reback et al (2012) had an additional outcome regarding the frequency of methamphetamine use among MSM [50], and Hightow-Weidman et al (2019) investigated the intention to use a condom, attitudes toward safe sexual behaviours, condom use self-efficacy, depressive symptoms, social support and social isolation [49].…”

“…Four SMS-based interventions were performed using prepost [50,92] (n = 2) and quasi-experimental designs [63,66] (n = 2).…”

“…Notably, the authors developed personalized messages based on several behavioural theories, which possibly enhanced the effectiveness of the intervention [50]. Another SMS and email-based pre-post pilot intervention was conducted by Fuchs et al [92], offering iText-a system delivering interactive check-in SMS and emails weekly to remind PrEP adherence. Authors reported significant reductions of missed doses at 50% (p = 0.008] and 77% (p = 0.007) when comparing self-reported missed days and pill counts at quarterly visits before and after intervention [92].…”

“…Another SMS and email-based pre-post pilot intervention was conducted by Fuchs et al [92], offering iText-a system delivering interactive check-in SMS and emails weekly to remind PrEP adherence. Authors reported significant reductions of missed doses at 50% (p = 0.008] and 77% (p = 0.007) when comparing self-reported missed days and pill counts at quarterly visits before and after intervention [92]. In India, a pilot RCT conducted by Mimiaga et al [82] using text/voice messages via mobile phone to encourage male sex workers using condom during sexual encounters.…”

Development and Evaluation of Mobile Application for the Prevention of Musculoskeletal Risks in Nursing Work

“…19 The popularity of handheld devices, such as smartphones, with their portability, functionality and connectivity, have been gaining space and social and professional recognition in a number of areas, joining a variety of applications mainly in the area of health. [20][21][22][23][24] The International Labor Organization (ILO) 2 considers that the use of mHealth, encourages the exchange of knowledge and additional research for promotion at work, as well as the World Health Organization, who also encourages the investment of mobile applications for various purposes in areas such as monitoring, epidemiological surveillance, management, care promotion, prevention, and remote patient care, as it allows the individual to have greater participation in their care. 25 With increasing usage and different user profiles, it is important to ensure that applications address usability requirements.…”