Study Examines the Effectiveness of Increased Adolescent PrEP Usage With Automated Text Messaging

PrEP pill © magann - stock.adobe.com

Condom use, post-exposure prophylaxis, and sexual partner number reduction are all proven methods to reduce the spread of HIV, but usage of pre-exposure prophylaxis (PrEP), which has the potential to nearly eliminate HIV, is low, especially in younger people.

Of the 1,216,210 people in the United States who would benefit from PrEP, only 22.7% (275,794) used it, according to a study from the Centers for Disease Control and Prevention, published in 2019. Percentages were even lower among people ages 16-24, with only 15% (246,290) using PrEP.

To figure out the best way to boost PrEP adherence in young people, a team of researchers led by Dallas Swendeman, Ph.D., organized a randomized, four arm study, the results of which were published in the Mar. 2024 edition of The Lancet.

The team wished to see what methods would be the most effective in increasing PrEP usage and adherence in young people. To do so, researchers separated 895 enrollees into four groups. For participants to meet study criteria, they had to be considered at risk for HIV, living in Los Angeles or New Orleans and 12-24 years old. Each group was subject to one of the following tactics: automated text messaging and monitoring (AAMI), AAMI plus telehealth coaching, AAMI plus private social media support and AAMI plus online peer support and coaching. This method was chosen because of the low cost and high reach of sending text messages. In addition, more than 95% of US teenagers have a mobile phone.

Researchers discovered that the most effective method was a combination of AAMI, online peer support and telehealth coaching.

“This study provides evidence that disruptive innovation approaches of simpler, flexible, and adaptable interventions designed for diffusion (ie, easily adoptable and adaptable) that account for diverse and competing needs and syndemic factors can improve PrEP uptake,” the authors write. “This is in contrast to current norms for highly scripted and brief interventions narrowly targeting HIV prevention or PrEP uptake that do not provide ongoing support during varying periods of risk and developmental transitions.”

The research team goes on to say that the AAMI worked because it was noninvasive and engaging and that the success of the peer support and telehealth coaching created a safe sense of community that destigmatized HIV and allowed the mentors to provide trusted guidance.

“Future analyses will examine implementation costs for all interventions in detail in conjunction with cost-effectiveness analyses and modeling medical and societal costs,” the authors write.