Effectiveness of PrEPTECH: Findings From a 180-Day Randomized Controlled Trial of a Pre-Exposure Prophylaxis Telehealth Intervention.

BACKGROUND: Telehealth approaches are increasingly being used to provide access to pre-exposure prophylaxis (PrEP), an effective but underused HIV prevention modality. This randomized controlled trial of PrEPTECH, a telehealth intervention for the provision of HIV PrEP, seeks to assess its effects on PrEP access. METHODS: Young men who have sex with men and transgender women in Florida and California with an indication for PrEP were randomly assigned in a 1:1 allocation to receive access to PrEPTECH or a control condition, access to an online listing of PrEP resources in their communities. This intent-to-treat analysis used logistic and linear regression to compare self-reported PrEP initiation, use, and coverage between control and intervention arm participants at 90 days and 180 days of follow-up. RESULTS: A total of 229 participants with a mean age of 23.7 years, 77.3% people of color enrolled in PrEPTECH. At 90 days, postbaseline initiation of PrEP was significantly higher among those in the PrEPTECH arm than among controls (odds ratio [OR]: 6.63, 95% confidence interval [CI]: 2.54 to 17.35), and this held true by 180 days post baseline. The count of sex acts for which participants were not protected by PrEP, PrEP adherence, and recent PrEP use at 180 days post baseline were not significantly different between the study arms. CONCLUSIONS: Receiving access to a telehealth platform for PrEP access increased PrEP initiation in this cohort of young, predominantly non-White sexual and gender minorities. PrEP telehealth may be a worthy avenue for providing access to PrEP for these populations, but additional strategies may be needed to promote adherence and persistence of PrEP use.

Effectiveness, Acceptability, and Feasibility of a Telehealth HIV Pre-Exposure Prophylaxis Care Intervention Among Young Cisgender Men and Transgender Women Who Have Sex With Men: Protocol for a Randomized Controlled Trial.

BACKGROUND: Despite its promise for HIV prevention, the uptake of pre-exposure prophylaxis (PrEP) has been slow, and there have been substantial inequities in PrEP access. Young men who have sex with men and transgender women of color are most in need of PrEP and least likely to have that need fulfilled. PrEP telehealth care, which provides remote PrEP care via electronic communication, seems well suited to address several of the challenges of PrEP provision, including discomfort with stigmatizing and difficult-to-access health care systems, transportation challenges, and privacy concerns, and address disparities in PrEP access. Research suggests that PrEP telehealth care has promise and is a favored option for many prospective recipients of PrEP. However, despite growing attention to telehealth approaches as an avenue for increasing access to PrEP amidst the COVID-19 pandemic, there have been no published randomized controlled trials (RCTs) on PrEP telehealth care to date, making it difficult to draw strong conclusions about the advantages or disadvantages of telehealth compared with usual PrEP care. We developed PrEPTECH, a telehealth intervention that focuses specifically on alleviating issues of stigma, access, cost, and confidentiality for young people with risk factors for HIV infection who are seeking PrEP care. Leveraging data from the 2017 observational pilot study, we redesigned and enhanced PrEPTECH. OBJECTIVE: This study aims to assess the effectiveness, acceptability, and feasibility of a telehealth HIV PrEP care intervention, PrEPTECH, in increasing PrEP uptake. METHODS: This is the protocol for an RCT of young cisgender men and transgender women who have sex with men in 4 regions within the United States: the San Francisco Bay Area, California; Los Angeles County, California; Miami-Dade County, Florida; and Broward County, Florida. Participants in the intervention arm received access to a web-based telehealth program, PrEPTECH, which offers a fully web-based pathway to PrEP, whereas those in the control arm received access to a dynamic web page containing publicly available informational resources about PrEP. Follow-up data collection occurred at 3 and 6 months. An analysis will be conducted on outcomes, including PrEP initiation, persistence, adherence, coverage, and medication prescription, as well as PrEPTECH acceptability and feasibility. RESULTS: The study was funded in 2019 and received institutional review board approval in 2020. The PrEPTECH intervention was developed over the next 1.5 years. Study recruitment was launched in February 2022 and completed in September 2022, with 229 participants recruited in total. Data collection was completed in April 2023. CONCLUSIONS: The results of this RCT will offer valuable evidence regarding the effectiveness, acceptability, and feasibility of telehealth HIV PrEP care interventions among young cisgender men and transgender women who have sex with men. TRIAL REGISTRATION: ClinicalTrials.gov NCT04902820; https://clinicaltrials.gov/ct2/show/NCT04902820. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/47932.

The hookup: collaborative evaluation of a youth sexual health program using text messaging technology.

BACKGROUND: The Hookup is a collaborative project reaching young people in California with valuable sexual and reproductive health information and linkage to local resources. Due to limited access to subscriber contact information, it has been a challenge to evaluate the program. OBJECTIVE: The aims of this study were to determine the feasibility of using text messaging (short message service, SMS) as an evaluation tool for an educational text message-based program and to evaluate the program itself. METHODS: All subscribers of The Hookup were sent four survey questions via SMS about age, gender, location, referral source and behavior change. An incentive was offered for completing the survey and an opt-out option was provided in the initial message. RESULTS: All existing subscribers of The Hookup (N=2477) received a request to complete the survey using the SMS application on their mobile phones. A total of 832 (33.6%) subscribers responded to the initial question and 481 (20%) answered all four questions. Of the responses, 85% were received in the first two hours of the initial request. Respondents who answered the question about behavior change, 90% reported having made some positive change since subscribing to Hookup, including getting tested for STDs and HIV. CONCLUSIONS: The survey methodology initiated a high response rate from The Hookup subscribers. The survey was able to provide data about subscribers in a short time period at minimal cost. The results show potential for using mobile SMS applications to evaluate SMS campaigns. The findings also support using SMS to provide young people with sexual health prevention messaging and linkage to health services.

Associations among text messaging, academic performance, and sexual behaviors of adolescents.

BACKGROUND: Text messaging is an increasingly common mode of communication, especially among adolescents, and frequency of texting may be a measure of one's sociability. This study examined how text messaging ("texting") frequency and academic performance are associated with adolescent sexual behaviors. METHODS: A cross-sectional survey was administered to students at a public charter high school in Los Angeles County, CA. Two hundred fifty-six high school students aged 14-20 years participated. Outcome measures were history of vaginal sex, condom use, and worries about pregnancy. The main predictors were text messaging frequency and self-reported academic performance. RESULTS: In general, students with lower grades were more likely to have had vaginal sex. Greater texting frequency, however, was associated with vaginal sex only among students with higher grades. In addition, despite similar rates of condom use, sexually active students who both had good grades and texted frequently were more likely than others to have thought they or their partner might be pregnant. CONCLUSIONS: The association between texting and sexual behaviors may vary based on adolescent's academic performance. Adolescent sexual health interventions may benefit from using a combination of sociability measures (such as texting frequency) and academic performance as risk predictors.

Adolescents' perspectives on the use of a text messaging service for preventive sexual health promotion.

PURPOSE: To understand adolescents' perspectives on the use of a preventive sexual health text messaging service. METHODS: Twenty-six adolescents aged 15-20 years old were recruited from two teen clinics in Los Angeles County to participate in focus groups. Three focus groups were held. Discussions focused on the content of the weekly text messages sent by a service called the Hookup, as well as the acceptability of using text messaging to relay sexual health education to adolescents. Codes and themes were developed from transcripts using standard constant comparison methods. RESULTS: Participants enjoyed receiving weekly text messages related to sexual health. They linked their enjoyment to the message content being informative (providing relevant and new information), simple (automatically limited to small words and short phrases), and sociable (easily able to be shared with friends). Participants also pointed to the convenience and ubiquity of text messaging and generally felt that cost of messages was not a concern. Most felt that text messaging provided a sense of privacy for learning about sensitive health topics, although a few expressed concerns about stigma from peers' seeing the messages. CONCLUSIONS: Teens may face several barriers to accessing reliable, useful, and age-appropriate information and services for their health. The use of text messaging is an innovative way to engage teens in preventive health learning and practices. Text messaging may allow efficient delivery of health messages and may offer a discreet way for teens to learn important health information, especially for sensitive topics like sexual health.

Bridging the gap: using school-based health services to improve chlamydia screening among young women.

OBJECTIVES: We implemented a chlamydia screening program targeted at young women accessing reproductive health care services in a school-based setting, and we assessed racial/ethnic factors associated with infection. METHODS: The California Family Health Council partnered with 9 health care agencies receiving federal Title X family planning funding and 19 educational institutions to implement the Educational Partnerships to Increase Chlamydia Screening (EPICS) program from January 2008 through December 2008. RESULTS: EPICS agencies provided reproductive health services to 3396 unique sexually active females, 85% of whom self-reported no other source for reproductive health care. Chlamydia screening was provided to 3026 clients (89.1% chlamydia screening coverage). Of those screened for chlamydia, 5.6% tested positive. Clients who were African American (odds ratio [OR]=7.5; 95% confidence interval [CI]=3.9, 14.3), Pacific Islander (OR=4.1; 95% CI=1.1, 15.5), or Asian (OR=3.3; 95% CI=1.4, 8.1) were more likely to have a positive test than were White clients. CONCLUSIONS: Chlamydia screening programs implemented in school-based settings have the capacity to identify and treat a significant amount of asymptomatic infection in a population that otherwise may not be reached. To facilitate screening, school-based clinics should implement outreach strategies that target their school population and clinical strategies that maximize opportunities for screening.