Youth-friendly services and a mobile phone application to promote adherence to pre-exposure prophylaxis among adolescent men who have sex with men and transgender women at-risk for HIV in Thailand: a randomized control trial

Wipaporn Natalie Songtaweesin, Surinda Kawichai, Nittaya Phanuphak, Tim R Cressey, Prissana Wongharn, Chutima Saisaengjan, Tanat Chinbunchorn, Surang Janyam, Danai Linjongrat, Thanyawee Puthanakit, CE-PID - TRC Adolescent Study Team, Praphan Phanuphak, Chitsanu Pancharoen, Somsong Teeratakulpisarn, Reshmie Ramautarsing, Rena Janamnuaysook, Kritima Samitpol, Jiratchaya Kongkapan, Artsanee Chancham, Pravit Mingkwanrungruang, Narukjaporn Thammajaruk, Nuttawut Teachatanawat, Krittaporn Termvanich, Tippawan Pankam, Thantip Sungsing, Sorawit Amatavete, Chotika Prabjantuek, Phubet Panpet, Jureeporn Jantarapakde, Tuangtip Theerawit, Watsamon Jantarabenjakul, Suvaporn Anugulruengkitt, Nattapong Jitrunruengnit, Noppadol Wacharachaisurapol, Pintip Suchartlikitwong, Pakpoom Janewongwirot, Juthamanee Moonwong, Rachaneekorn Nadsasarn, Patchareeyawan Srimuan, Siwanart Thammasala, Sasiwimol Ubolyam, Patcharin Eamyoung, Jiratchaya Sophonphan, Stephen Kerr, Taninee Petwijit, Chansuda Bongsebandhu-Phubakdi, Buajoom Raksakul, Pathranis Meekrua, Orawan Fungfoosri, Prapaipan Plodgratoke, Pakitta Kidsumret, Kamolchanok Chumyen, Sahakun Chintanakarn, Sirinthon Yenjit, Chanin Suksom, Tanunjit Rugphan, Somsri Tantipaibulvut, Prakaipech Kaw-In, Penprapa Chanachon, Chanjiraporn Pondet, Wipaporn Natalie Songtaweesin, Surinda Kawichai, Nittaya Phanuphak, Tim R Cressey, Prissana Wongharn, Chutima Saisaengjan, Tanat Chinbunchorn, Surang Janyam, Danai Linjongrat, Thanyawee Puthanakit, CE-PID - TRC Adolescent Study Team, Praphan Phanuphak, Chitsanu Pancharoen, Somsong Teeratakulpisarn, Reshmie Ramautarsing, Rena Janamnuaysook, Kritima Samitpol, Jiratchaya Kongkapan, Artsanee Chancham, Pravit Mingkwanrungruang, Narukjaporn Thammajaruk, Nuttawut Teachatanawat, Krittaporn Termvanich, Tippawan Pankam, Thantip Sungsing, Sorawit Amatavete, Chotika Prabjantuek, Phubet Panpet, Jureeporn Jantarapakde, Tuangtip Theerawit, Watsamon Jantarabenjakul, Suvaporn Anugulruengkitt, Nattapong Jitrunruengnit, Noppadol Wacharachaisurapol, Pintip Suchartlikitwong, Pakpoom Janewongwirot, Juthamanee Moonwong, Rachaneekorn Nadsasarn, Patchareeyawan Srimuan, Siwanart Thammasala, Sasiwimol Ubolyam, Patcharin Eamyoung, Jiratchaya Sophonphan, Stephen Kerr, Taninee Petwijit, Chansuda Bongsebandhu-Phubakdi, Buajoom Raksakul, Pathranis Meekrua, Orawan Fungfoosri, Prapaipan Plodgratoke, Pakitta Kidsumret, Kamolchanok Chumyen, Sahakun Chintanakarn, Sirinthon Yenjit, Chanin Suksom, Tanunjit Rugphan, Somsri Tantipaibulvut, Prakaipech Kaw-In, Penprapa Chanachon, Chanjiraporn Pondet

Abstract

Introduction: Strategies are needed to curb the increasing HIV incidence in young men who have sex with men (YMSM) and transgender women (YTGW) worldwide. We assessed the impact of youth-friendly services (YFS) and a mobile phone application (app) on adherence to pre-exposure prophylaxis (PrEP) in YMSM and YTGW in Thailand.

Methods: A randomized control trial was conducted in YMSM and YTGW aged 15 to 19 years. Participants were provided daily oral tenofovir disoproxil fumerate/emtricitabine (TDF/FTC), condoms and randomized to receive either YFS or YFS plus a PrEP app (YFS + APP), whose features included self-assessment of HIV acquisition risk, point rewards and reminders for PrEP and clinic appointments. Clinic visits occurred at zero, one, three and six months and telephone contact at two, four and five months. HIV testing was performed at every clinic visit. PrEP adherence was evaluated with intracellular tenofovir diphosphate (TFV-DP) concentrations in dried blood spot (DBS) samples at months 3 and 6. The primary endpoint assessed was "PrEP adherence" defined as TFV-DP DBS concentrations ≥700 fmol/punch (equivalent to ≥4 doses of TDF/week).

Results: Between March 2018 and June 2019, 489 adolescents were screened at three centres in Bangkok. Twenty-seven (6%) adolescents tested positive for HIV and 200 (41%) adolescents participated in the study. Of these, 147 were YMSM (74%) and 53 YTGW (26%). At baseline, median age was 18 years (IQR 17 to 19), 66% reported inconsistent condom use in the past month. Sexually transmitted infection prevalence was 23%. Retention at six months was 73%. In the YFS + APP arm, median app use duration was three months (IQR 1 to 5). PrEP adherence at month 3 was 51% in YFS and 54% in YFS + APP (p-value 0.64) and at month 6 was 44% in YFS and 49% in YFS + APP (p-value 0.54). No HIV seroconversions occurred during 75 person years of follow-up.

Conclusions: Youth-friendly PrEP services enabled good adherence among half of adolescent PrEP users. However, the mobile phone application tested did not provide additional PrEP adherence benefit in this randomized trial. Adolescent risk behaviours are dynamic and require adaptive programmes that focus on "prevention-effective adherence."

Trial registration: ClinicalTrials.gov NCT03778892.

Keywords: HIV prevention; adolescents; men who have sex with men (MSM); pre-exposure prophylaxis (PrEP) adherence; transgender women (TGW).

© 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.

Figures

Figure 1
Figure 1
Adherence to once daily oral HIV pre‐exposure 3 prophylaxis at months 3 and 6 of follow‐up by randomization arm. YFS, Youth‐friendly services; YFS + APP, Youth‐friendly services plus mobile phone application use.
Figure 2
Figure 2
Mode of protection of risk periods against HIV and STIs seen in Thai adolescents. “PrEP protection” defined as ≥700 fmol/punch, “condom protection” defined as 100% condom use. PrEP, pre‐exposure prophylaxis; STIs, sexually transmitted infections.

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