Hightow-Weidman Lisa B, Rainer Crissi, Schader Lindsey, Rosso Matthew T, Benkeser David, Cottrell Mackenzie, Tompkins Lauren, Claude Kristina, Stocks Jacob B, Yigit Ibrahim, Budhwani Henna, Muessig Kathryn E
Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
AIDS Behav. 2025 Feb;29(2):652-663. doi: 10.1007/s10461-024-04547-0. Epub 2024 Nov 12.
The population-level reductions in HIV incidence attributed to pre-exposure prophylaxis (PrEP) have not been fully realized among sexual, gender, and racial/ethnic minority youth. P3 (Prepared, Protected, emPowered) is a comprehensive mobile application (app) intervention developed to support PrEP adherence through gamification, medication tracking, and social engagement. A randomized controlled trial was conducted with 246 young men who have sex with men (YMSM) and young transgender women who have sex with men (YTWMSM) currently on or planning to begin PrEP. Participants were randomized in a 1:1:1 ratio to: standard of care (SOC), P3 app (P3), or P3 app plus in-app adherence coaching (P3+). Adherence was measured at 3- and 6- months post enrollment by emtricitabine-triphosphate (FTC-TP) and tenofovir-diphosphate (TFV-DP) levels in dried blood spots consistent with PrEP use > 4 days/week. The primary outcome was the difference in the proportion adherent comparing P3/P3+ to SOC. P3/P3+ was associated with a higher proportion adherent compared to SOC for both outcome measures. At 3 months, the estimated increase in the proportion adherent was 0.13 (95% CI: 0.00, 0.27, p: 0.05) and 0.12 (95% CI: -0.03, 0.26, p: 0.11) for TFV-DP and FTC-TP, respectively. Estimated adherence was higher, but not statistically different, in P3+ compared to P3, for both TFV-DP and FTC-TP. Receipt of P3 (P3 or P3+) is associated with an increase in PrEP adherence among YMSM and YTWSM at 3 months. Additional analyses to discern the role of app usage and sociodemographic and behavioral factors on intervention effects are warranted.
在性少数、性别少数以及种族/族裔少数青年群体中，暴露前预防（PrEP）在降低人群层面的HIV发病率方面尚未完全发挥作用。P3（有备、有护、有力）是一款综合性移动应用程序（应用）干预措施，旨在通过游戏化、药物追踪和社交互动来支持PrEP的依从性。对246名男男性行为青年（YMSM）和与男性发生性行为的年轻跨性别女性（YTWMSM）进行了一项随机对照试验，这些人目前正在接受或计划开始PrEP。参与者按1:1:1的比例随机分为：标准治疗（SOC）、P3应用程序（P3）或P3应用程序加应用内依从性指导（P3+）。在入组后3个月和6个月时，通过干血斑中的替诺福韦二磷酸（TFV-DP）和恩曲他滨三磷酸（FTC-TP）水平来测量依从性，这些水平与每周使用PrEP超过4天一致。主要结局是比较P3/P3+与SOC的依从比例差异。对于这两种结局指标，P3/P3+与比SOC更高的依从比例相关。在3个月时，TFV-DP和FTC-TP的依从比例估计增加分别为0.13（95%CI：0.00，0.27，p：0.05）和0.12（95%CI：-0.03，0.26，p：0.11）。对于TFV-DP和FTC-TP，P3+的估计依从性高于P3，但无统计学差异。在3个月时，接受P3（P3或P3+）与YMSM和YTWSM中PrEP依从性的增加相关。有必要进行额外分析，以确定应用程序使用以及社会人口学和行为因素对干预效果的作用。
