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A Mobile Phone App to Support Adherence to Daily HIV Pre-exposure Prophylaxis Engagement Among Young Men Who Have Sex With Men and Transgender Women Aged 15 to 19 Years in Thailand: Pilot Randomized Controlled Trial.
JMIR Mhealth Uhealth. 2022 Apr 21; 10(4):e25561.JM

Abstract

BACKGROUND

Widespread smartphone use provides opportunities for mobile health HIV prevention strategies among at-risk populations.

OBJECTIVE

This study aims to investigate engagement in a theory-based (information-motivation-behavioral skills model) mobile phone 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 controlled 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, including 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). The target population focus group discussion findings and the information-motivation-behavioral skills model informed app development. App features were based on the 3Rs-risk assessment of self-HIV acquisition risk, reminders to take PrEP, and rewards as redeemable points. Dried blood spots quantifying of tenofovir diphosphate were collected at months 3 and 6 to assess PrEP adherence. Tenofovir diphosphate ≥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 of follow-up.

RESULTS

Between March 2018 and June 2019, 200 participants with a median age of 18 (IQR 17-19) years were enrolled. Overall, 74% (148/200) were YMSM; 87% (87/100) of participants who received YFS+APP logged in to the app and performed weekly HIV acquisition risk assessments (log-in and risk assessment [LRA]). The median duration between the first and last log-in was 3.5 (IQR 1.6-5.6) months, with a median frequency of 6 LRAs (IQR 2-10). Moreover, 22% (22/100) of the participants in the YFS+APP arm were frequent users (LRA≥10) during the 6-month follow-up period. YMSM were 9.3 (95% CI 1.2-74.3) times more likely to be frequent app users than YTGW (P=.04). Frequent app users had higher proportions (12%-16%) of PrEP adherence at both months 3 and 6 compared with infrequent users (LRA<10) and the YFS arm, although this did not reach statistical significance. Of the 100 participants in the YFS+APP arm, 23 (23%) were interviewed. The risk assessment function is perceived as the most useful app feature. Further aesthetic adaptations and a more comprehensive rewards system were suggested by the interviewees.

CONCLUSIONS

Higher rates of PrEP adherence among frequent app users were observed; however, this was not statistically significant. A short app use duration of 3 months suggests that they may be useful in establishing habits in taking daily PrEP, but not long-term adherence. Further studies on the specific mechanisms of mobile phone apps that influence health behaviors are needed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03778892; https://clinicaltrials.gov/ct2/show/NCT03778892.

Authors+Show Affiliations

Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand.Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand.Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand.Institute of HIV Research and Innovation, Bangkok, Thailand.The Program for HIV Prevention and Treatment/ Unité Mixte de recherches Internationale 174, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand. Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom.Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand.Focal Intelligence Co Ltd, Bangkok, Thailand.Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand.Institute of HIV Research and Innovation, Bangkok, Thailand.Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand. Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

35451976

Citation

Kawichai, Surinda, et al. "A Mobile Phone App to Support Adherence to Daily HIV Pre-exposure Prophylaxis Engagement Among Young Men Who Have Sex With Men and Transgender Women Aged 15 to 19 Years in Thailand: Pilot Randomized Controlled Trial." JMIR mHealth and UHealth, vol. 10, no. 4, 2022, pp. e25561.
Kawichai S, Songtaweesin WN, Wongharn P, et al. A Mobile Phone App to Support Adherence to Daily HIV Pre-exposure Prophylaxis Engagement Among Young Men Who Have Sex With Men and Transgender Women Aged 15 to 19 Years in Thailand: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth. 2022;10(4):e25561.
Kawichai, S., Songtaweesin, W. N., Wongharn, P., Phanuphak, N., Cressey, T. R., Moonwong, J., Vasinonta, A., Saisaengjan, C., Chinbunchorn, T., & Puthanakit, T. (2022). A Mobile Phone App to Support Adherence to Daily HIV Pre-exposure Prophylaxis Engagement Among Young Men Who Have Sex With Men and Transgender Women Aged 15 to 19 Years in Thailand: Pilot Randomized Controlled Trial. JMIR mHealth and UHealth, 10(4), e25561. https://doi.org/10.2196/25561
Kawichai S, et al. A Mobile Phone App to Support Adherence to Daily HIV Pre-exposure Prophylaxis Engagement Among Young Men Who Have Sex With Men and Transgender Women Aged 15 to 19 Years in Thailand: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth. 2022 Apr 21;10(4):e25561. PubMed PMID: 35451976.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Mobile Phone App to Support Adherence to Daily HIV Pre-exposure Prophylaxis Engagement Among Young Men Who Have Sex With Men and Transgender Women Aged 15 to 19 Years in Thailand: Pilot Randomized Controlled Trial. AU - Kawichai,Surinda, AU - Songtaweesin,Wipaporn Natalie, AU - Wongharn,Prissana, AU - Phanuphak,Nittaya, AU - Cressey,Tim R, AU - Moonwong,Juthamanee, AU - Vasinonta,Anuchit, AU - Saisaengjan,Chutima, AU - Chinbunchorn,Tanat, AU - Puthanakit,Thanyawee, Y1 - 2022/04/21/ PY - 2020/11/7/received PY - 2021/12/9/accepted PY - 2021/2/11/revised PY - 2022/4/22/entrez PY - 2022/4/23/pubmed PY - 2022/4/27/medline KW - PrEP adherence KW - adolescents KW - mHealth KW - men who have sex with men KW - mobile phone KW - transgender women SP - e25561 EP - e25561 JF - JMIR mHealth and uHealth JO - JMIR Mhealth Uhealth VL - 10 IS - 4 N2 - BACKGROUND: Widespread smartphone use provides opportunities for mobile health HIV prevention strategies among at-risk populations. OBJECTIVE: This study aims to investigate engagement in a theory-based (information-motivation-behavioral skills model) mobile phone 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 controlled 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, including 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). The target population focus group discussion findings and the information-motivation-behavioral skills model informed app development. App features were based on the 3Rs-risk assessment of self-HIV acquisition risk, reminders to take PrEP, and rewards as redeemable points. Dried blood spots quantifying of tenofovir diphosphate were collected at months 3 and 6 to assess PrEP adherence. Tenofovir diphosphate ≥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 of follow-up. RESULTS: Between March 2018 and June 2019, 200 participants with a median age of 18 (IQR 17-19) years were enrolled. Overall, 74% (148/200) were YMSM; 87% (87/100) of participants who received YFS+APP logged in to the app and performed weekly HIV acquisition risk assessments (log-in and risk assessment [LRA]). The median duration between the first and last log-in was 3.5 (IQR 1.6-5.6) months, with a median frequency of 6 LRAs (IQR 2-10). Moreover, 22% (22/100) of the participants in the YFS+APP arm were frequent users (LRA≥10) during the 6-month follow-up period. YMSM were 9.3 (95% CI 1.2-74.3) times more likely to be frequent app users than YTGW (P=.04). Frequent app users had higher proportions (12%-16%) of PrEP adherence at both months 3 and 6 compared with infrequent users (LRA<10) and the YFS arm, although this did not reach statistical significance. Of the 100 participants in the YFS+APP arm, 23 (23%) were interviewed. The risk assessment function is perceived as the most useful app feature. Further aesthetic adaptations and a more comprehensive rewards system were suggested by the interviewees. CONCLUSIONS: Higher rates of PrEP adherence among frequent app users were observed; however, this was not statistically significant. A short app use duration of 3 months suggests that they may be useful in establishing habits in taking daily PrEP, but not long-term adherence. Further studies on the specific mechanisms of mobile phone apps that influence health behaviors are needed. TRIAL REGISTRATION: ClinicalTrials.gov NCT03778892; https://clinicaltrials.gov/ct2/show/NCT03778892. SN - 2291-5222 UR - https://www.unboundmedicine.com/medline/citation/35451976/A_Mobile_Phone_App_to_Support_Adherence_to_Daily_HIV_Pre_exposure_Prophylaxis_Engagement_Among_Young_Men_Who_Have_Sex_With_Men_and_Transgender_Women_Aged_15_to_19_Years_in_Thailand:_Pilot_Randomized_Controlled_Trial_ DB - PRIME DP - Unbound Medicine ER -