Mobile app leads to increased HIV PrEP uptake among users in Thailand

According to a study published in Journal of Internet Medical Research.

Although the authors stated that the results were not statistically significant and may not indicate long-term adherence due to the short duration of the study, they suggested that using the app can help establish daily PrEP habits.

The study was conducted in Thailand between March 2018 and June 2019 with 200 participants, including young Thai men who have sex with men (YMSM) and young transgender women (YTGW). The median age (IQR) of the participants was 18 (17-19), and most (74%) of the participants were YMSMs.

In the randomized controlled trial, 100 participants received 6 months of youth-friendly PrEP services (YFS), which included monthly engagement with site staff via an in-person visit or phone call, and the opportunity to contact the staff and advisors outside of scheduled visits. The remaining 100 participants were randomized to receive YFS in addition to the use of Project Raincoat PrEP Adherence Support App (YFS+APP).

The mobile app’s functionality was based on what the authors called the 3Rs: risk assessment, reminders, and rewards.

Adherence to PrEP was assessed at months 3 and 6 using dried blood drops containing tenofovir diphosphate, and patient perspectives on adherence were collected during exit interviews and were generally positive about the ease of use of the app.

“Designing the app for ease of use clearly influenced the likelihood that participants would use the app,” the authors wrote. “This observation is consistent with previous studies that have found that simple interfaces can reduce the time participants have to spend on the app and therefore improve retention.”

Respondents also indicated that the risk rating feature was considered the app’s most useful feature and suggested changes to the look of rewards and the overall aesthetics of the app.

In the YFS+APP group, 87% of participants used the app and completed the weekly HIV risk assessments. Additionally, 22% were considered frequent app users, defined as logging in and reviewing at least 10 times during the 6-month period.

Overall, the median duration (IQR) from first to last login was 3.5 (1.6-5.6) months, with a median login frequency and risk assessment (LRA) of 6 LRAs.

The authors also found variations in the frequency of LRA between YMSM and YTGW participants. The study showed that YMSMs were 9.3 times more likely to be considered frequent app users compared to YTGW (95% CI, 1.2-74.3; P = 0.04).

Frequency of app use has been shown to be related to PrEP adherence, although not statistically significant. At months 3 and 6, frequent users had higher proportions of adherence between 12% and 16%, compared to infrequent users with LRAs less than 10 and participants in the YFS group.

The authors highlighted the need for additional research focused on the specific mechanisms of apps that influence health behaviors, especially in low- and middle-income areas with limited staff.

“The development and implementation of MHealth will ultimately benefit health access and HIV prevention service delivery beyond its current applications in the current COVID-19 pandemic,” said concluded the authors.

Reference

Kawichai S, Songtaweesin WN, Wongharn P, et al. A mobile phone app to support adherence to daily HIV pre-exposure prophylaxis commitment among young men who have sex with men and transgender women aged 15-19 years in Thailand: a randomized controlled pilot trial . JMIR Mhealth Uhealth. 2022;10(4):e25561. doi:10.2196/25561