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Title: Youth-friendly services and a mobile phone application to promote adherence to pre-exposure prophylaxis among adolescent men who have sex with men and transgender women at-risk for HIV in Thailand: a randomized control trial
Authors: Wipaporn Natalie Songtaweesin
Surinda Kawichai
Nittaya Phanuphak
Tim R. Cressey
Prissana Wongharn
Chutima Saisaengjan
Tanat Chinbunchorn
Surang Janyam
Danai Linjongrat
Thanyawee Puthanakit
Praphan Phanuphak
Chitsanu Pancharoen
Somsong Teeratakulpisarn
Reshmie Ramautarsing
Rena Janamnuaysook
Kritima Samitpol
Jiratchaya Kongkapan
Artsanee Chancham
Pravit Mingkwanrungruang
Narukjaporn Thammajaruk
Nuttawut Teachatanawat
Krittaporn Termvanich
Tippawan Pankam
Thantip Sungsing
Sorawit Amatavete
Chotika Prabjantuek
Phubet Panpet
Jureeporn Jantarapakde
Tuangtip Theerawit
Watsamon Jantarabenjakul
Suvaporn Anugulruengkitt
Nattapong Jitrunruengnit
Noppadol Wacharachaisurapol
Pintip Suchartlikitwong
Pakpoom Janewongwirot
Juthamanee Moonwong
Rachaneekorn Nadsasarn
Patchareeyawan Srimuan
Siwanart Thammasala
Sasiwimol Ubolyam
Patcharin Eamyoung
Jiratchaya Sophonphan
Stephen Kerr
Taninee Petwijit
Chansuda Bongsebandhu-phubakdi
Buajoom Raksakul
Pathranis Meekrua
Orawan Fungfoosri
Prapaipan Plodgratoke
Pakitta Kidsumret
Kamolchanok Chumyen
Sahakun Chintanakarn
Sirinthon Yenjit
Chanin Suksom
Tanunjit Rugphan
Somsri Tantipaibulvut
Prakaipech Kaw-In
Penprapa Chanachon
Chanjiraporn Pondet
Keywords: Medicine
Issue Date: 1-Sep-2020
Abstract: © 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. Introduction: Strategies are needed to curb the increasing HIV incidence in young men who have sex with men (YMSM) and transgender women (YTGW) worldwide. We assessed the impact of youth-friendly services (YFS) and a mobile phone application (app) on adherence to pre-exposure prophylaxis (PrEP) in YMSM and YTGW in Thailand. Methods: A randomized control trial was conducted in YMSM and YTGW aged 15 to 19 years. Participants were provided daily oral tenofovir disoproxil fumerate/emtricitabine (TDF/FTC), condoms and randomized to receive either YFS or YFS plus a PrEP app (YFS + APP), whose features included self-assessment of HIV acquisition risk, point rewards and reminders for PrEP and clinic appointments. Clinic visits occurred at zero, one, three and six months and telephone contact at two, four and five months. HIV testing was performed at every clinic visit. PrEP adherence was evaluated with intracellular tenofovir diphosphate (TFV-DP) concentrations in dried blood spot (DBS) samples at months 3 and 6. The primary endpoint assessed was “PrEP adherence” defined as TFV-DP DBS concentrations ≥700 fmol/punch (equivalent to ≥4 doses of TDF/week). Results: Between March 2018 and June 2019, 489 adolescents were screened at three centres in Bangkok. Twenty-seven (6%) adolescents tested positive for HIV and 200 (41%) adolescents participated in the study. Of these, 147 were YMSM (74%) and 53 YTGW (26%). At baseline, median age was 18 years (IQR 17 to 19), 66% reported inconsistent condom use in the past month. Sexually transmitted infection prevalence was 23%. Retention at six months was 73%. In the YFS + APP arm, median app use duration was three months (IQR 1 to 5). PrEP adherence at month 3 was 51% in YFS and 54% in YFS + APP (p-value 0.64) and at month 6 was 44% in YFS and 49% in YFS + APP (p-value 0.54). No HIV seroconversions occurred during 75 person years of follow-up. Conclusions: Youth-friendly PrEP services enabled good adherence among half of adolescent PrEP users. However, the mobile phone application tested did not provide additional PrEP adherence benefit in this randomized trial. Adolescent risk behaviours are dynamic and require adaptive programmes that focus on “prevention-effective adherence.”.
ISSN: 17582652
Appears in Collections:CMUL: Journal Articles

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