Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 12, 2022
Date Accepted: Jul 12, 2022
Effect of Reminder System on Pre-exposure Prophylaxis Adherence in Men Who Have Sex with Men: A Prospective Cohort Study Based on WeChat Intervention
ABSTRACT
Background:
The efficacy of pre-exposure prophylaxis (PrEP) is highly dependent on adherence, and one of the main reasons for poor adherence is forgetfulness, therefore it is important considering about how to remind users to take their medicine.
Objective:
This study aims to explore the effect of reminder system on PrEP adherence among men who have sex with men (MSM) to improve adherence.
Methods:
An open-label, multicenter, prospective cohort study of PrEP in HIV-negative MSM was conducted from November 2019 to June 2021. Study subjects who met the criteria were randomly divided into no reminder group and reminder group and received daily oral PrEP with follow-up every three months. Study subjects in the reminder group scanned a WeChat QR (Quick Response) code and received a reminder message every day. The no reminder group took daily oral medicine without reminders. Longitudinal trajectories of adherence were displayed for both groups to compare the variability in adherence at each time point. The association between changes in adherence (no change, improvement, decline) at each time point and the use of the reminder system was analyzed by multinomial logistic regression models to further explore the effectiveness of the system.
Results:
A total of 716 MSM were included in the analysis, including 372 in the no reminder group and 344 in the reminder group. Adherence in the no reminder group fluctuated between 0.75 and 0.80; in the reminder group gradually increased over time, from 0.76 to 0.88. Adherence at each time point were not statistically different between the two groups. An improvement in adherence in the early stage was associated with the use of reminder system [odds ratio (OR)=1.653, p=0.0439]. An improvement in average adherence compared to initial adherence was positively associated with the use of reminder system (OR=1.818, p=0.0203).
Conclusions:
The effect of the reminder system on PrEP adherence in MSM was more significant in the early stage, which is related to the increased motivation of users and the development of medicine taking habits. The reminder system is potentially effective for early-stage medicine management, encouraging users in developing healthy medicine taking habits and increasing their adherence. Clinical Trial: Chinese Clinical Trial Registration number: ChiCTR190026414; http://www.chictr.org.cn/showproj.aspx?proj=35077
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