JMIR Publications

ABSTRACT

Background:

Pre-exposure prophylaxis (PrEP) is a powerful tool to prevent the transmission of HIV. Interventions promoting this medication must focus on populations most impacted by systemic barriers to uptake. Historically, young sexual minority men (YSMM) and transgender women have the highest demonstrated rates of new HIV diagnoses, but prevalence within other gender minority populations is now being studied. To date, few interventions have focused exclusively on addressing PrEP uptake with sexual and gender minority (SGM) youth, particularly through mobile health (mHealth) technologies. Built on the successful foundation of the HealthMpowerment (HMP) Platform, PrEPresent aimed to engage with SGM youth across diverse gender and racial and ethnic identities in the Greater Los Angeles area.

Objective:

The aim of this study was to evaluate the feasibility and acceptability of a digital peer patient-navigation PrEP uptake application.

Methods:

The PrEPresent intervention took place over a 6-month timepoint with visits at baseline, 3 months, and 6 months. The active intervention period lasted from baseline to 3 months. Control participants received an information only version of the app. Intervention participants received an enhanced app with additional features and access to an interventionalist, the PrEPresentative. Intervention participants could meet with the PrEPresentative 4 times over the 3-month period via phone, HIPPA-compliant video conferencing, or in-app text messaging system. PrEP uptake was measured through survey response and UrSure rapid urine test of tenofovir.

Results:

PrEPresent comprised of 147 sexual and gender diverse participants – 48.3% (71/147) were Latinx and 18.4% (27/147) were Black/African American. Most (66.6%, 98/147) were transgender or gender diverse and the remainder (33.3%, 49/147) were cisgender men. PrEP was initiated by 14/56 (25.0%) of intervention participants and 11/58 (19.0%) of control participants. 50% (36/72) of intervention participants completed two or more sessions with the interventionalist. Intervention participants had an average of 15.93 logins compared to 6.31 logins for control participants. Average usage of the mHealth platform was 9.51 minutes for intervention participants and 3.03 minutes for control participants.

Conclusions:

PrEPresent met primary outcome measure metrics of feasibility and acceptability, demonstrating that mHealth-based peer-navigator support has potential to increase PrEP uptake in racially and ethnically diverse SGM. Despite this, PrEP uptake was low across both arms and usage of the platform was low compared to other iterations of HMP projects. While mHealth offers promising HIV prevention outcomes, fostering active participant app engagement will continue to be crucial in promoting behavior change. With the widescale adoption of on-demand and long-acting injectable PrEP, interventions targeting uptake and adherence will need to adapt as the landscape of PrEP delivery evolves. Larger trials powered for efficacy are warranted to understand how mHealth platforms and peer-navigation systems can address barriers related to PrEP uptake. Clinical Trial: ClinicalTrials.gov NCT05281393; https://clinicaltrials.gov/ct2/show/NCT05281393