Study finds that combining digital medical interventions doubles uptake of HIV prevention drugs

A study led by UCLA Health found that a combination of interventions, including one-on-one telehealth coaching, peer support forums, and automated text messages, increased uptake of an HIV prevention strategy called PrEP among at-risk youth by 2. It turns out that the number has more than doubled. A group that has historically used fewer drugs.

The results of the randomized controlled trial are lancet digital healthThe U.S. Centers for Disease Control and Prevention is targeting interventions to improve HIV prevention behaviors, including pre-exposure prophylaxis (PrEP), among young Americans, who have historically had the lowest rates of drug use among the U.S. population of 1.2 million. I tested the combination. (CDC) estimates that they will benefit from the drug.

Approved by the U.S. Food and Drug Administration in 2012, PrEP is given as a pill or injection to prevent HIV infection. When taken as prescribed, this drug reduces the risk of sexually transmitted HIV by 99%, according to the CDC.

It is estimated that only 15% of Americans ages 16 to 24 are using PrEP, compared to the national average of 25% for all ages combined. According to the CDC, uptake rates are lowest among blacks (8%) and Latinos (14%).

Dallas Swendeman, lead study author and professor in UCLA’s Department of Psychiatry and Biobehavioral Sciences, found that medical mistrust, affordability, access to health care, having parental insurance, and discomfort talking about sexual activity He stated that there are several factors behind this distrust of medical care. Basic survival needs such as doctors, substance use, housing, food, and income.

The two-year study recruited nearly 900 residents from Los Angeles and New Orleans who identified as gay, bisexual, transgender, or other sexual minority youth. Approximately 40% of participants were Black, 29% were Latino, 21% were White, and 6% were Asian or Pacific Islander.

Participants were randomly divided into four groups, and each group received a different combination of interventions, including automated text messages, private social media forums, and one-on-one strengths-based telehealth coaching with a close paraprofessional. I did.

After the first 8 months, PrEP uptake increased from 11% at baseline to more than 20% in the group receiving all three interventions. This was the highest of all his four groups and was maintained throughout the 24-month follow-up.

The study authors said this increase, if implemented nationwide, could help bend the curve of new HIV infections among young Americans in the absence of other prevention strategies. His PrEP use in his three other study groups increased to about 15% by 8 months, but then decreased.

“Science is developing biomedical innovations at an impressive rate, but as we’ve seen with COVID-19 vaccines and PrEP for HIV prevention, getting people to use them is extremely difficult. ” Swendeman said. “We still need behavioral interventions and wraparound services to support people with whole-person care so that they can prioritize not only HIV prevention but also other competing needs and priorities in their lives.”

Furthermore, in a separate analysis, the researchers found that participants assigned to two study groups that included telehealth coaching experienced significantly worse mental health outcomes over time compared to groups that received only automated text messages and online peer support. They found that they remained more involved in support services for housing, food, and financial security. .

The study also investigated whether the intervention affected condom use. Use of drug post-exposure prophylaxis (PEP), which is used to prevent HIV infection after potential exposure. and partner number. Swendeman said no effects were observed in these areas.

While the study results show promise, Swendeman said they need to be tested in more real-world situations before they can be scaled up. He is currently conducting another federally funded implementation science study in partnership with community-based organizations to identify barriers, facilitators, and optimal implementation strategies for these interventions in real-world practice. I am leading.

“We need to engage more actively with behavioral and implementation science to bridge the translational gap between biomedical discovery, dissemination, and impact,” Swendeman said.