Text messages improve PrEP adherence among young people

Using a text message-based intervention can improve pre-exposure prophylaxis, or PrEP, retention and adherence among young adults aged between 18 and 29 years, according to research published in Clinical Infectious Diseases. Researchers noted that young people are least likely to use PrEP and, if initiated, are very likely to discontinue the drug’s use.

The researchers also added that young men who have sex with men (MSM) are a population with a very high risk for HIV infection in the United States, and that black and Latino MSM accounted for more than 75% of new infections in 2015.

“The effectiveness of [short message service (SMS)]-based interventions to increase retention and adherence to antiretroviral medication in HIV-positive individuals has been demonstrated and more recently, the role of SMS-based strategies in supporting PrEP adherence has been investigated,” Albert Y. Liu, MD, a resident physician at the University of California, San Francisco, and colleagues wrote. Mobile health technologies have enormous potential to support HIV prevention and adherence in youth, in whom cell phone ownership is nearly universal.”

In a randomized controlled trial called the EPIC study, participants were assigned in a 2:1 ratio to a youth-tailored, bidirectional text-messaging PrEP support intervention (PrEPmate) or standard of care for 36 weeks. The researchers compared the groups’ retention and adherence to PrEP.

Of the 121 participants who enrolled between April 2015 and March 2016, those who used PrEPmate were more likely to attend visits required for the study compared with those who received standard of care (86% vs. 71%; OR = 2.62; 95% CI, 1.24-5.54). Furthermore, those who were randomly assigned to receive PrEPmate demonstrated adherence through tenofovir diphosphate concentrations consistent with four or more doses per week (72% vs. 57%; OR = 2.05; 95% CI, 1.06-3.94).

The researchers observed that the efficacy of PrEPmate did not change significantly between participants considering their age, race or ethnicity, education level or insurance coverage. Most participants who used PrEPmate (88%) rated the intervention as very or somewhat helpful, and even more (92%) reported that they would recommend it to others.

“As the FDA recently approved the PrEP indication for tenofovir diphosphate in youth aged younger than 18 years, evaluation of PrEPmate and other PrEP adherence support tools in adolescents at risk for HIV acquisition is warranted,” Liu and colleagues wrote. “Broader implementation of this interactive tool to support PrEP retention and adherence has the potential to maximize the public health impact of PrEP among youth highly vulnerable to HIV infection.” – by Katherine Bortz

Disclosures: Liu was an investigator on studies for which Gilead Sciences has donated the study drug. Please see the study for all other authors’ relevant financial disclosures.