Initial results are promising in a study using texting support to buttress adherence to Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP) among young transgender women and cisgender men who have sex with men (MSM).
Although the ongoing study has not yet yielded results to indicate how well the texting intervention lowered overall HIV risk, interim findings show that the group as a whole has adhered well to the daily Truvada regimen.
These first results were presented at the HIV Research for Prevention (HIVR4P) conference in Chicago. Between April 2015 and March 2016, researchers screened 134 at-risk trans women and MSM 18 to 29 years old. If enrolled, they received PrEP at the Chicago CORE PrEP clinic and were randomized two to one to receive the texting intervention Prepmate or just the clinic’s standard of care for PrEP recipients, including counseling support from a health educator.
Of the 121 people enrolled in the study, 28 percent were black, 36 percent Latino, 25 percent white and 7 percent Asian. Ninety-five percent were male, and the remaining 5 percent were trans or genderqueer. Three quarters had some college education or higher, and half had an income below $20,000 per year. Seventy-eight percent had health insurance.
The study will be completed in November 2016.
The researchers tested for adherence to Truvada through dried blood spot tests at weeks 4, 12, 24 and 36 of the study.
The current data on the retention of the 121 participants in the study is incomplete because some participants have completed more weeks of the study than others, and it is not possible to compare retention rates between points in time. That said, 93 percent of the participants who were four weeks into the study were retained at that point. The retention figures for those expected to make weeks 12, 24 and 36 were 83 percent, 75 percent and 71 percent respectively.
Of the 10 people who withdrew from the study early, six did so because of insurance or payment problems (the participants needed to secure insurance coverage for PrEP or pay out of pocket), three because of changes in relationship (one of these people was also included in the payment problem tally), one due to side effects and one because of scheduling issues.
The proportion of the participants at each expected clinic visit with dried blood spot test results indicating that they were taking four or more tablets of Truvada per week (which confers maximum protection against HIV) was 92 percent, 90 percent, 81 percent and 84 percent at weeks 4, 12, 24 and 36. Again, because not all participants have yet been expected to make each visit, it is not possible at this time to compare adherence rates over time.
The proportion of study visits showing adherence at the level of four pills per week or more broken down by race was 96 percent for whites, 91 percent for Asians, 88 percent for Latinos and 80 percent for blacks. Across racial groups, most people showed high adherence at all study visits.
Blacks were less likely than whites to have protective levels of Truvada, as were those without insurance compared with those who were insured.
The rate of protective levels of Truvada did not differ by participants’ income, reported alcohol or drug use, depressive symptoms or sexual risk behaviors.