Real-World User Experiences with a Digital Pill System to Measure PrEP Adherence: Perspectives from MSM with Substance Use

Chai, Peter R; Goodman, Georgia R; Bronzi, Olivia; Gonzales, Gerard Bryan; Baez, Alejandro; Bustamante, María José; Najarro, Jesse; Mohamed, Yassir A.; Sullivan, Matthew C.; Mayer, Kenneth H.; Boyer, Edward W.; O’Cleirigh, Conall; Rosen, Rochelle K.

doi:10.1007/s10461-022-03594-9

Cited by 11 publications

(5 citation statements)

References 22 publications

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“…Previous pilot data from individuals with TB using ingestible sensor systems for ATT in the United States demonstrate high patient acceptance of the system and a desire to remain on DPS-based ATT adherence monitoring compared to DOT [ 16 ]. These sentiments mirror our previous work in HIV pre-exposure chemoprophylaxis that demonstrates high patient acceptance of these systems [ 24 – 26 ]. We anticipate that prior to deployment in India, patient perspectives of the DPS should be explored.…”

Section: Discussionsupporting

confidence: 82%

Formative acceptance of ingestible biosensors to measure adherence to TB medications

et al. 2022

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Background Tuberculosis (TB) represents a significant public health threat in India. Adherence to antitubercular therapy (ATT) is the key to reducing the burden of this infectious disease. Suboptimal adherence to ATT and lack of demonstrated feasibility of current strategies for monitoring ATT adherence highlights the need for alternative adherence monitoring systems. Methods A quantitative survey was conducted to assess the acceptance of and willingness to use a digital pill system (DPS) as a tool for monitoring ATT adherence among stakeholders directly involved in the management of patients with TB in India. Participants reviewed a video explaining the DPS and completed a survey, which covered sociodemographics, degree of involvement with TB patients, initial impressions of the DPS, and perceived challenges for deploying the technology in India. Participants were also asked to interpret mock DPS adherence data. Results The mean age was 34.3 (SD = 7.3), and participants (N = 50) were predominantly male (70%). The sample comprised internists (52%) and pulmonologists (30%), with a median of 4 years’ experience (IQR 3, 6) in the management of TB patients. No participants had previously used a DPS, but some reported prior awareness of the technology (22%). Most reported that they would recommend use of a DPS to patients on ATT (76%), and that they would use a DPS in both the intensive and continuation phases of TB management (64%). The majority viewed the DPS (82%) as a useful alternative to directly observed therapy-short course (DOTS), particularly given the ongoing COVID-19 pandemic. Participants reported that a DPS would be most effective in patients at risk of nonadherence (64%), as well as those with past nonadherence (64%). Perceived barriers to DPS implementation included lack of patient willingness (92%), cost (86%), and infrastructure constraints (66%). The majority of participants were able to accurately interpret patterns of adherence (80%), suboptimal adherence (90%), and frank nonadherence (82%) when provided with mock DPS data. Conclusions DPS are viewed as an acceptable, feasible, and useful technology for monitoring ATT adherence by stakeholders directly involved in TB management. Future investigations should explore patient acceptance of DPS and pilot demonstration of the system in the TB context.

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Section: Discussionsupporting

confidence: 82%

Formative acceptance of ingestible biosensors to measure adherence to TB medications

et al. 2022

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“…Our data currently represent one of the largest and most detailed study available on UX in persons with any medical diagnosis who have experience using an IS medication adherence system. Our findings are in line with those of Chai et al [56], who reported from qualitative interviews that 15 out of 90 persons using a digital pill system (DPS) [2] for PrEP adherence measurement perceived the device as acceptable, novel, and valuable. Interestingly, men who have sex with men (MSM) taking PrEP who reported substance use were also found to have positive perceptions toward using the DPS in the future [57].…”

Section: Principal Findingssupporting

confidence: 92%

“…Significant differences were observed between questionnaire nonrespondents and respondents, limiting the generalizability of our findings to persons taking PrEP who are homeless or use methamphetamine. In the latter regard, it is notable that Chai et al [56,57] report positive UX and attitude findings regarding DPS technology in MSM taking PrEP who use substances. Despite being one of the largest detailed study available on UX in persons who used an IS medication adherence system, our sample size was limited, and as the probability of reporting a positive experience was observed in >75% of the study population, the likelihood of identifying "current and future use personas" across our study was restricted by our sample size.…”

Section: Limitationsmentioning

confidence: 99%

User Experience of Persons Using Ingestible Sensor–Enabled Pre-Exposure Prophylaxis to Prevent HIV Infection: Cross-Sectional Survey Study

Browne,

Umlauf,

Moore

et al. 2024

JMIR Mhealth Uhealth

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Background A digital health technology’s success or failure depends on how it is received by users. Objectives We conducted a user experience (UX) evaluation among persons who used the Food and Drug Administration–approved Digital Health Feedback System incorporating ingestible sensors (ISs) to capture medication adherence, after they were prescribed oral pre-exposure prophylaxis (PrEP) to prevent HIV infection. We performed an association analysis with baseline participant characteristics, to see if “personas” associated with positive or negative UX emerged. Methods UX data were collected upon exit from a prospective intervention study of adults who were HIV negative, prescribed oral PrEP, and used the Digital Health Feedback System with IS-enabled tenofovir disoproxil fumarate plus emtricitabine (IS-Truvada). Baseline demographics; urine toxicology; and self-report questionnaires evaluating sleep (Pittsburgh Sleep Quality Index), self-efficacy, habitual self-control, HIV risk perception (Perceived Risk of HIV Scale 8-item), and depressive symptoms (Patient Health Questionnaire–8) were collected. Participants with ≥28 days in the study completed a Likert-scale UX questionnaire of 27 questions grouped into 4 domain categories: overall experience, ease of use, intention of future use, and perceived utility. Means and IQRs were computed for participant total and domain subscores, and linear regressions modeled baseline participant characteristics associated with UX responses. Demographic characteristics of responders versus nonresponders were compared using the Fisher exact and Wilcoxon rank-sum tests. Results Overall, 71 participants were enrolled (age: mean 37.6, range 18-69 years; n=64, 90% male; n=55, 77% White; n=24, 34% Hispanic; n=68, 96% housed; and n=53, 75% employed). No demographic differences were observed in the 63 participants who used the intervention for ≥28 days. Participants who completed the questionnaire were more likely to be housed (52/53, 98% vs 8/10, 80%; P=.06) and less likely to have a positive urine toxicology (18/51, 35% vs 7/10, 70%; P=.08), particularly methamphetamine (4/51, 8% vs 4/10, 40%; P=.02), than noncompleters. Based on IQR values, ≥75% of participants had a favorable UX based on the total score (median 3.78, IQR 3.17-4.20), overall experience (median 4.00, IQR 3.50-4.50), ease of use (median 3.72, IQR 3.33-4.22), and perceived utility (median 3.72, IQR 3.22-4.25), and ≥50% had favorable intention of future use (median 3.80, IQR 2.80-4.40). Following multipredictor modeling, self-efficacy was significantly associated with the total score (0.822, 95% CI 0.405-1.240; P<.001) and all subscores (all P<.05). Persons with more depressive symptoms reported better perceived utility (P=.01). Poor sleep was associated with a worse overall experience (−0.07, 95% CI −0.133 to −0.006; P=.03). Conclusions The UX among persons using IS-enabled PrEP (IS-Truvada) to prevent HIV infection was positive. Association analysis of baseline participant characteristics linked higher self-efficacy with positive UX, more depressive symptoms with higher perceived utility, and poor sleep with negative UX.

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“…Such conversations should carefully consider the intersection of race, ethnicity, and existing levels of medical mistrust on users’ perceptions of the DPS and ancillary systems [ 27 ]. Our previous work suggests that the use of these monitoring technologies may, in fact, increase one’s sense of personal accountability for their PrEP adherence, as well as improve relationships with medical providers by providing objective data around PrEP ingestions, and the context in which they occur, to long-term primary care and sexual health services [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous qualitative work demonstrated that MSM with substance use are accepting of DPS technology, willing to operate it in the real world to measure PrEP adherence, and perceive value in having on-demand access to PrEP adherence data [ 8 , 10 ]. Additionally, a recent study surveyed a national sample of MSM on PrEP who use substances to understand broader perceptions of the DPS and willingness to interact with the system for PrEP adherence measurement [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Acceptance of digital phenotyping linked to a digital pill system to measure PrEP adherence among men who have sex with men with substance use

Albrechta,

Goodman,

Oginni

et al. 2024

PLOS Digit Health

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Once-daily oral HIV pre-exposure prophylaxis (PrEP) is an effective strategy to prevent HIV, but is highly dependent on adherence. Men who have sex with men (MSM) who use substances face unique challenges maintaining PrEP adherence. Digital pill systems (DPS) allow for real-time adherence measurement through ingestible sensors. Integration of DPS technology with other digital health tools, such as digital phenotyping, may improve understanding of nonadherence triggers and development of personalized adherence interventions based on ingestion behavior. This study explored the willingness of MSM with substance use to share digital phenotypic data and interact with ancillary systems in the context of DPS-measured PrEP adherence. Adult MSM on PrEP with substance use were recruited through a social networking app. Participants were introduced to DPS technology and completed an assessment to measure willingness to participate in DPS-based PrEP adherence research, contribute digital phenotyping data, and interact with ancillary systems in the context of DPS-based research. Medical mistrust, daily worry about PrEP adherence, and substance use were also assessed. Participants who identified as cisgender male and were willing to participate in DPS-based research (N = 131) were included in this subsample analysis. Most were White (76.3%) and non-Hispanic (77.9%). Participants who reported daily PrEP adherence worry had 3.7 times greater odds (95% CI: 1.03, 13.4) of willingness to share biometric data via a wearable device paired to the DPS. Participants with daily PrEP adherence worry were more likely to be willing to share smartphone data (p = 0.006) and receive text messages surrounding their daily activities (p = 0.003), compared to those with less worry. MSM with substance use disorder, who worried about PrEP adherence, were willing to use DPS technology and share data required for digital phenotyping in the context of PrEP adherence measurement. Efforts to address medical mistrust can increase advantages of this technology for HIV prevention.

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Real-World User Experiences with a Digital Pill System to Measure PrEP Adherence: Perspectives from MSM with Substance Use

Cited by 11 publications

References 22 publications

Formative acceptance of ingestible biosensors to measure adherence to TB medications

Formative acceptance of ingestible biosensors to measure adherence to TB medications

User Experience of Persons Using Ingestible Sensor–Enabled Pre-Exposure Prophylaxis to Prevent HIV Infection: Cross-Sectional Survey Study

Acceptance of digital phenotyping linked to a digital pill system to measure PrEP adherence among men who have sex with men with substance use

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