Smartphone-Based Contingency Management Intervention to Improve Pre-Exposure Prophylaxis Adherence: Pilot Trial

• Published in: JMIR mHealth and uHealth Vol. 6; no. 9; p. e10456
• Main Authors: Mitchell, John T, LeGrand, Sara, Hightow-Weidman, Lisa B, McKellar, Mehri S, Kashuba, Angela Dm, Cottrell, Mackenzie, McLaurin, Tony, Satapathy, Goutam, McClernon, F Joseph
• Format: Journal Article
• Language: English
• Published: Canada JMIR Publications 01.09.2018
• Subjects: Behavior modification; Biomarkers; Disease prevention; HIV; Human immunodeficiency virus; Intervention; Laboratories; Likert scale; Original Paper; Patient compliance; Questionnaires; Smartphones; Usability; United States > US; HIV; mobile health; preexposure prophylaxis
• ISSN: 2291-5222; 2291-5222
• DOI: 10.2196/10456

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. 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. 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). 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. 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. ClinicalTrials.gov NCT02895893; https://clinicaltrials.gov/ct2/show/NCT02895893 (Accessed by Webcite at http://www.webcitation.org/72JskjDJq).