Smartphone-Based Contingency Management Intervention to Improve Pre-Exposure Prophylaxis Adherence: Pilot Trial.
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Abstract
BACKGROUND Pre exposure prophylaxis PrEP provides a strong preventative benefit to individuals at risk for HIV While PrEP adherence is highly correlated with its efficacy adherence rates are variable both across and within persons OBJECTIVE The objective of this study was to develop and pilot test a smartphone based intervention known as mSMART that targets PrEP adherence mSMART provides contingency management in the form of monetary incentives for daily PrEP adherence based on a real time adherence assessment using a camera based medication event monitoring tool as well as medication reminders PrEP education individualized behavioral strategies to address PrEP adherence barriers and medication adherence feedback METHODS This was a 4 week open label phase I trial in a community sample of young men who have sex with men already on PrEP N 10 RESULTS Although adherence composite scores corresponding to PrEP biomarkers indicated that 90 9 10 of the sample already had an acceptable baseline adherence in the protective range by the end of the 4 week period the scores improved for 30 3 10 of the sample adherence did not worsen for any participants Participants reported mean PrEP adherence rates of 91 via daily entries in mSMART At the end of the 4 week period participants indicated acceptable ratings of satisfaction usability and willingness to recommend mSMART to others There were no technical difficulties associated with smartphone compatibility user misunderstandings about mSMART features that interfered with daily use or study attrition CONCLUSIONS This study is the first to apply contingency management to PrEP adherence Findings indicated that mSMART is feasible and acceptable Such an adherence intervention administered via a user friendly smartphone app can allow for widespread dissemination Future efficacy trials are needed TRIAL REGISTRATION ClinicalTrials gov NCT02895893 https clinicaltrials gov ct2 show NCT02895893 Accessed by Webcite at http www webcitation org 72JskjDJq