Mhealth for Pre-exposure Prophylaxis Adherence by Young Adult MSM - Abstract: Environment and Health Group, Tufts HIV/AIDS Clinic, and the Boston-area PrEP
Community of Practice will collaborate under the leadership of Patricia Weitzman, PhD, to
develop and test the feasibility and short-term effectiveness of the first-ever individually-tailored,
developmentally- and culturally-sensitive, mobile (mhealth) PrEP adherence tool. It will target
culturally-diverse, young adult men ages 20-29 who have sex with men (YMSM). When PrEP is
taken daily, it can reduce HIV risk by up to 92%. The CDC estimates PrEP is appropriate for
500,000 MSM in the U.S. Impact models show even modest PrEP adherence could reduce new
HIV infections among MSM by 29% over 20 years. The recent rise in HIV infection among
young adults age 20-29, particularly minority YMSM, points to the value of PrEP uptake and
adherence support for culturally-diverse YMSM. In PrEP trials, younger age was the most
consistent correlate with low PrEP adherence. Extensive mobile phone penetration among
young adults makes mhealth an ideal, low-cost method for providing PrEP adherence support to
YMSM. We bring together a developmental understanding of young adult decision making with
principles from social learning theory and positive psychology for supporting PrEP adherence.
The proposed project is based on Dr. Weitzman's successful Phase 1 (and current Phase
2) anti-retroviral therapy (ART) mhealth adherence intervention for HIV+ African Americans,
which combined tailored pill reminders with age- and culturally-sensitive motivational and
educational texts. Experts suggest building PrEP adherence interventions on proven ART
adherence interventions as many PrEP adherence facilitators are the same as ART. Moreover,
the growing literature on mhealth shows it is a powerful approach to supporting adherence across
conditions. In addition to building on our prior ART mhealth tool, we address facilitators/barriers
identified in PrEP RCT follow up studies, and CDC PrEP adherence recommendations.
Moreover, formative focus groups with diverse YMSM will allow us to identify and target unique
adherence barriers and facilitators in this group. The intervention will provide tailored pill
reminders with PrEP education texts, as well as developmentally-sensitive motivational texts.
We will include sleep hygiene and alcohol use messages, which have direct relevance to young
adults. By using a low-cost, accessible mobile phone tool, the intervention eliminates several
access barriers to support, which can be a particular problem for low income and minority
patients. Our overarching goal is to help stop the rise in HIV among YMSM.
