Daily short message service surveys to measure sexual behavior and pre-exposure prophylaxis use among Kenyan men and women

Abstract

Pre-exposure prophylaxis (PrEP) is a novel HIV prevention strategy which requires high adherence. We tested the use of daily short message service (i.e., SMS/text message) surveys to measure sexual behavior and PrEP adherence in Kenya. Ninety-six HIV-uninfected adult individuals, taking daily oral PrEP in a clinical trial, received daily SMS surveys for 60 days. Most participants (96.9 %) reported taking PrEP on ≥80 % days, but 69.8 % missed at least one dose. Unprotected sex was reported on 4.9 % of days; however, 47.9 % of participants reported unprotected sex at least once. Unprotected sex was not correlated with PrEP use (OR = 0.95). Participants reporting more sex were less likely to report PrEP non-adherence and those reporting no sex were most likely to report missing a PrEP dose (adjusted OR = 1.87). PrEP adherence was high, missed doses were correlated with sexual abstinence, and unprotected sex was not associated with decreased PrEP adherence.

Figures

Fig. 1

Flow chart of participant enrollment, survey distribution, and response rates. The target sample size for this study was 100. Study staff approached Partners PrEP clinical trial participants for enrollment during their monthly clinic visits. Some participants had already completed maximum follow-up for the Partners PrEP Study clinical trial at the time this pilot evaluation was conducted. A total of 110 participants were enrolled in the study, of which 96 participants responded to ≥5 of 7 daily surveys during the 1st week run-in. Of 5,760 surveys planned for 96 participants over 60 days, 5,412 surveys were distributed, 32 surveys were cancelled after one participant exited due to pregnancy, and 316 surveys were not delivered due to a mid-study block by a local mobile phone provider