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. 2022 Jan 18;12(1):ibab117.
doi: 10.1093/tbm/ibab117.

Development of a digital pill and respondent behavioral intervention (PrEPSteps) for HIV pre-exposure prophylaxis adherence among stimulant using men who have sex with men

Peter R Chai  1   2   3   4 , Yassir Mohamed  1 , Georgia Goodman  1   5 , Maria J Bustamante  1 , Matthew C Sullivan  1   5 , Jesse Najarro  1 , Lizette Mendez  1 , Kenneth H Mayer  1   6 , Edward W Boyer  1   2 , Conall O'Cleirigh  1   5 , Rochelle K Rosen  7   8
Affiliations

Development of a digital pill and respondent behavioral intervention (PrEPSteps) for HIV pre-exposure prophylaxis adherence among stimulant using men who have sex with men

Peter R Chai et al. Transl Behav Med. .

Abstract

The efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention in men who have sex with men (MSM) is contingent upon consistent adherence. Digital pill systems (DPS) provide real-time, objective measurement of ingestions and can inform behavioral adherence interventions. Qualitative feedback was solicited from MSM who use stimulants to optimize a cognitive behavioral therapy (CBT)-based intervention (LifeSteps), used in conjunction with a DPS, to promote PrEP adherence (PrEPSteps). Seven focus groups and one individual qualitative interview were conducted in Boston, MA with cisgender, HIV-negative MSM who reported stimulant use and current PrEP use or interest. Focus groups and interviews explored reactions to the DPS and PrEPSteps messaging components: contingent reinforcement (CR), corrective feedback (CF), LifeSteps, and substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT). Quantitative assessments were administered. Qualitative data were analyzed using applied thematic analysis. Twenty MSM participated. Most were White (N = 12), identified as homosexual or gay (N = 15), and college-educated (N = 15). Ages ranged from 24 to 68 years (median 35.5). Participants were willing to engage with the DPS and viewed it as beneficial for promoting adherence. Confirmatory CR messages were deemed acceptable, and a neutral tone was preferred. CF messages were viewed as most helpful and as promoting individual responsibility. LifeSteps was perceived as useful for contextualizing nonadherence. However, SBIRT was a barrier to DPS use; concerns around potential substance use stigma were reported. MSM who use stimulants were accepting of the DPS and PrEPSteps intervention. CR, CF, and LifeSteps messages were viewed as helpful, with modifications pertaining to tone and content; SBIRT messages were not preferred.

Keywords: Digital pills; HIV prevention; Ingestible sensors; Medication adherence; Technology acceptance model.

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Figures

Fig 1
Fig 1
The digital pill system (DPS; ID-Cap System, eTectRx, Gainesville FL) consists of an ingestible radiofrequency emitter that co-encapsulates PrEP (1); on ingestion, the digital pill is activated, and its signal is acquired by a wearable Reader (2), which relays ingestion data to a smartphone app which enables on-demand access to adherence data (3). The app simultaneously transmits ingestion data to a clinician dashboard (4) which allows for real-time monitoring of ingestion data. Image courtesy of etectRx.
Fig 2
Fig 2
| Schematic of the PrEPSteps intervention demonstrating respondent interventions delivered based on daily PrEP adherence and nonadherence.
See this image and copyright information in PMC

References

    1. Anderson PL, Glidden DV, Liu A, et al. ; iPrEx Study Team . Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012;4(151):151ra125. - PMC - PubMed
    1. Batchelder AW, Safren S, Mitchell AD, Ivardic I, O’Cleirigh C. Mental health in 2020 for men who have sex with men in the United States. Sex Health. 2017;14(1):59–71. - PMC - PubMed
    1. Mayer KH, Skeer MR, O’Cleirigh C, Goshe BM, Safren SA. Factors associated with amplified HIV transmission behavior among American men who have sex with men engaged in care: Implications for clinical providers. Ann Behav Med. 2014;47(2):165–171. - PMC - PubMed
    1. Choi KW, Batchelder AW, Ehlinger PP, Safren SA, O’Cleirigh C. Applying network analysis to psychological comorbidity and health behavior: Depression, PTSD, and sexual risk in sexual minority men with trauma histories. j Consult Clin Psychol. 2017;85(12):1158–1170. - PMC - PubMed
    1. Safren SA, Blashill AJ, O’Cleirigh CM. Promoting the sexual health of MSM in the context of comorbid mental health problems. aids Behav. 2011;15(suppl 1):S30–S34. - PMC - PubMed

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