基于微信干预的提醒系统对男男性行为者预防用药依从性的影响：前瞻性队列研究。
Effect of a Reminder System on Pre-exposure Prophylaxis Adherence in Men Who Have Sex With Men: Prospective Cohort Study Based on WeChat Intervention.
机构信息
School of Public Health and Management, Chongqing Medical University, Chongqing, China.
Research Center for Medicine and Social Development, Chongqing, China.
出版信息
J Med Internet Res. 2022 Aug 11;24(8):e37936. doi: 10.2196/37936.
BACKGROUND
The efficacy of pre-exposure prophylaxis (PrEP) is highly dependent on adherence, and one of the main reasons for poor adherence is forgetfulness. Therefore, it is important to explore how to remind users to take their medicine on time.
OBJECTIVE
This study aims to explore the effect of a reminder system on PrEP adherence in men who have sex with men (MSM) to improve adherence. The main function of the reminder system based on the WeChat social media app is to send daily messages to PrEP users reminding them to take their medicine.
METHODS
An open-label, multicenter, prospective cohort study of PrEP in HIV-negative MSM was conducted from November 2019 to June 2021. Study participants who met the criteria were randomly divided into 2 groups: no-reminder group and reminder group. Both groups received daily oral PrEP with follow-up every 3 months. Adherence was measured on the basis of self-report and was defined as the percentage of medications taken on time. Participants in the reminder group scanned a WeChat QR code and received a reminder message every day. Participants in the no-reminder group took daily oral medicines without reminders. The longitudinal trajectories of adherence for both groups were displayed to compare the variability in adherence at each time point. The association between the changes in adherence (no change, improvement, decline) at each time point and the use of the reminder system was analyzed by multinomial logistic regression models to further explore the effectiveness of the system.
RESULTS
A total of 716 MSM were included in the analysis, that is, 372 MSM in the no-reminder group and 344 MSM in the reminder group. Adherence in the no-reminder group fluctuated between 0.75 and 0.80 and that in the reminder group gradually increased over time from 0.76 to 0.88. Adherence at each time point was not statistically different between the 2 groups. Further analysis showed that an improvement in adherence in the early stage was associated with the use of the reminder system (odds ratio [OR] 1.65, 95% CI 1.01-2.70; P=.04). An improvement in average adherence compared to initial adherence was positively associated with the use of the reminder system (OR 1.82, 95% CI 1.10-3.01; P=.02).
CONCLUSIONS
The effect of the reminder system on PrEP adherence in MSM was more significant in the early stage, which is related to the increased motivation of users and the development of medicine-taking habits. The reminder system is potentially effective for early-stage medicine management, encouraging users to develop healthy medicine-taking habits and to increase their adherence.
TRIAL REGISTRATION
Chinese Clinical Trial ChiCTR190026414; http://www.chictr.org.cn/showproj.aspx?proj=35077.
背景
暴露前预防（PrEP）的疗效高度依赖于依从性，而依从性差的主要原因之一是健忘。因此，探索如何提醒用户按时服药非常重要。
目的
本研究旨在探讨基于微信社交媒体应用程序的提醒系统对提高男男性行为者（MSM）PrEP 依从性的作用。该提醒系统的主要功能是每天向 PrEP 用户发送消息，提醒他们服药。
方法
这是一项 2019 年 11 月至 2021 年 6 月在 HIV 阴性 MSM 中进行的 PrEP 开放性、多中心、前瞻性队列研究。符合标准的研究参与者被随机分为 2 组：无提醒组和提醒组。两组均接受每日口服 PrEP 治疗，并每 3 个月随访一次。基于自我报告测量依从性，定义为按时服药的药物百分比。提醒组的参与者扫描微信二维码，每天收到提醒消息。无提醒组的参与者则每天口服药物，无提醒。比较两组在每个时间点的依从性纵向轨迹，以比较每个时间点的依从性变化（无变化、改善、下降）的可变性。通过多项逻辑回归模型分析每个时间点的依从性变化（无变化、改善、下降）与提醒系统使用之间的关联，进一步探讨系统的有效性。
结果
共有 716 名 MSM 纳入分析，即无提醒组 372 名，提醒组 344 名。无提醒组的依从性在 0.75 到 0.80 之间波动，而提醒组的依从性随着时间的推移逐渐从 0.76 增加到 0.88。两组各时间点的依从性无统计学差异。进一步分析表明，早期依从性的改善与使用提醒系统有关（比值比 [OR] 1.65，95%CI 1.01-2.70；P=0.04）。与初始依从性相比，平均依从性的改善与使用提醒系统呈正相关（OR 1.82，95%CI 1.10-3.01；P=0.02）。
结论
提醒系统对 MSM PrEP 依从性的影响在早期更为显著，这与用户积极性的提高和用药习惯的养成有关。提醒系统对于早期药物管理具有潜在的有效性，鼓励用户养成健康的用药习惯并提高其依从性。
试验注册
中国临床试验 ChiCTR190026414；http://www.chictr.org.cn/showproj.aspx?proj=35077。
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