JMIR Publications

ABSTRACT

Background:

Widespread smartphone use provides opportunities for HIV prevention delivery among at-risk populations.

Objective:

We evaluated user paradata in a theory-based (information-motivation-behavior, IMB skills model) mobile phone application (app) developed to support HIV pre-exposure prophylaxis (PrEP) adherence among Thai young men who have sex with men (YMSM) and young transgender women (YTGW) in Bangkok, Thailand.

Methods:

A randomized trial was conducted among HIV-negative YMSM and YTGW aged 15-19 years initiating daily oral PrEP. Participants were randomized to receive either youth-friendly PrEP services (YFS) for 6 months, which included monthly contact with site staff (clinic visits or telephone follow-up) and staff consultation access or YFS plus use of a PrEP adherence support app (YFS+APP). Target population focus group discussion findings and the IMB skills model informed app development. App features were based on the ‘3Rs’, (1) Risk-assessment of self HIV acquisition risk (2) Reminders to take PrEP with in-built alarms and (3) Rewards as redeemable point rewards. Dried blood spots (DBS) for quantification of tenofovir diphosphate (TFV-DP) were collected at months 3 and 6 to assess PrEP adherence, and TFV-DP ≥350-699 fmol/punch was classified as fair adherence and ≥700 fmol/punch as good adherence. Data analysis on app use paradata and exit interviews were conducted on the YFS+APP arm after 6 months follow-up.

Results:

Between March 2018 to June 2019, 200 participants with a median age of 18 years (IQR 17-19) were enrolled. Three quarters (74%) were YMSM. Eighty-seven of the 100 who received YFS+APP logged into the app and performed weekly HIV acquisition risk assessments (LRA). Median (IQR) duration between first and last login was 3.5 (1.6-5.6) months, with a median frequency of 6 LRAs (IQR 2-10). Twenty-two participants in the YFS+APP arm (24%) were frequent users (LRA≥10) during the 6-month follow-up period. YMSM were 9.3 times (95%CI 1.2-74.3) more likely to be frequent app users than YTGW (P =.04). There was a trend for frequent app users having higher proportions (12-24%) of fair and good PrEP adherence at both months 3 and 6 compared to infrequent users (LRA<10) and the YFS arm. Twenty-three of the YFS+APP arm were interviewed. The risk assessment function was perceived to be the most useful app feature. Further aesthetic adaptations and a more comprehensive rewards system was suggested by interviewees.

Conclusions:

We developed a mobile phone app that was integrated as part of a multimodal HIV prevention care package for adolescents. Although only one quarter of clients were frequent app users, a trend towards higher rates of PrEP adherence among frequent app users was observed. Interest in the app was maintained during the first 3 months, suggesting it may useful in helping to establish habits or understanding in taking daily PrEP, but not for maintenance of long-term adherence. Clinical Trial: ClinicalTrials.gov Identifier: NCT03778892.