Use of digital health interventions (dHealth) is linked to improved adherence to HIV PrEP adherence and is now recommended by the Community Preventive Services Task Force (CPSTF), according to a presentation by Theresa Sipe, PhD, MPH, MN, at the Association of Nurses in AIDS Care (ANAC) annual meeting held November 17 to 19, 2022, in Tampa, Florida.
The Ending the HIV Epidemic in the US goal is to reduce new HIV infections by 75% by 2025 and 90% by 2030. A key component of this plan is to increase use of pre-exposure prophylaxis (PrEP) in individuals who engage in behaviors such as multiple partners that may increase their chances of becoming infected with HIV.
When PrEP is taken daily as prescribed, sexual transmission of HIV is reduced by approximately 99% and transmission through injection drug use is reduced by at least 74%, according to CDC data. However, of the 1.2 million people in the US and Puerto Rico who could benefit from PrEP, only 25% were prescribed PrEP in 2020. Uptake is particularly low in Black and Hispanic/Latino populations (Figure).
Figure. PrEP Coverage During 2020 Among Persons Aged 16 Years and Older
The investigators conducted a systematic review of the HIV prevention literature to evaluate whether digital health interventions (dHealth) improve PrEP adherence and retention in PrEP care.
A total of 7 studies conducted between 2013 and 2020 were included in the review. Six were based in the US and 1 in The Netherlands. The dHealth interventions included text messages, emails, interactive online content, mobile apps, and iPhone gaming. The interventions reminded individuals to take their PrEP pill, tracked PrEP adherence, provided education, served as a support group, and/or provided counseling. All studies recruited men who have sex with men and the mean age of participants was 25 years. Black/African American and Hispanic/Latino populations were represented in some studies.
Because of HIPAA-related concerns regarding receiving HIV-related text messages, studies used language such as “time to take vitamin pills” to replace HIV-specific language, Dr Sipe noted.
Effects of Digital Health Interventions on PrEP Adherence
The dHealth interventions improved excellent PrEP adherence (7 doses/wk) by a median of 122% and good PrEP adherence (≥4 doses/wk) by a median of 11% when compared with standard care. In one study, the intervention increased patient retention in HIV PrEP care through week 36 compared with usual care (odds ratio [OR], 2.62; P =.01).
For HIV transmission outcomes, 1 study on dHealth interventions reported no HIV seroconversion events during a 74.3-person-year follow-up whereas another study reported 2 seroconversion events during a 577-person-year follow-up. In the 2 seroconversion events, the participants had discontinued PrEP.
The major limitation of this study was the small number of relevant studies.
These data indicated there were consistent and meaningful findings supporting dHealth for improving PrEP adherence and evidence from 1 study supported dHealth for maintaining patient retention, the researchers found.
Based on these data, the CPSTF recommends use of dHealth interventions to increase PrEP adherence. However, gaps in knowledge remain regarding the effects of dHealth in select patient populations such as older individuals, women, injection drug users, and non-English speakers.
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Sipe T, Kamitani E, Peng Y, et al. HIV prevention: Effectiveness of digital health interventions to improve adherence to HIV pre-exposure prophylaxis (PrEP). Presented at: ANAC2022; November 17-19, 2022; Tampa, FL.