[Viva] Fwd: Smartphone intervention found helpful for young men taking PrEP

Wed Oct 31 23:07:00 PDT 2018

Congratulations Tami! It's amazing they can cure HepC now, let's hold hope
for something as miraculous for HIV!
Let's put all our doctors into retirement!
:)
margarite

On Tue, Oct 30, 2018 at 9:42 AM Tami Starlight <tamistarlight at gmail.com>
wrote:

> For your info.
>
> Also. On another note. The BC NDP have fast tracked the HEPC / HCV
> treatment programs. I was fast tracked earlier this year and went through
> dr. hull at st pauls center for excellence. Cleared.
>
> So if anyone has both HIV and HCV. More options exist for the latter.
>
> Sent from my phone
> Tami Starlight
> (unceded coast salish territory/vancouver,canada)
> tamistarlight at gmail.com
> Twitter: @tamistarlight
> http://theantioppressionnetwork.com
> https://facebook.com/TheAntiOppressionNetworkUncededCoastSalish/
> <https://m.facebook.com/TheAntiOppressionNetworkUncededCoastSalish/>
>
>
> Begin forwarded message:
>
> *From:* CATIE News <mailer at catie.ca>
> *Date:* October 30, 2018 at 7:32:25 AM PDT
> *To:* <tamistarlight at gmail.com>
> *Subject:* *Smartphone intervention found helpful for young men taking
> PrEP*
> *Reply-To:* CATIE News <mailer at catie.ca>
>
> U.S. researchers developed a text messaging service to increase PrEP
> adherence
> [image: CATIE News]
>
> View this e-mail in your browser
> <https://mailchi.mp/c5fdd134cadf/smartphone-intervention-found-helpful-for-young-men-taking-prep?e=0f7b6f861c>
> Smartphone intervention found helpful for young men taking PrEP
>
>    - U.S. researchers developed a text messaging service to increase PrEP
>    adherence
>    - Healthcare providers used PrEPmate to send messages and reminders to
>    PrEP users
>    - Recipients were more likely to take PrEP as prescribed and attend
>    appointments
>
>
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>
> Clinical trials have demonstrated that pre-exposure prophylaxis (PrEP) can
> significantly reduce the risk of HIV infection. A key aspect of PrEP
> involves taking a fixed-dose combination of two drugs—tenofovir DF and
> FTC—sold under the brand name Truvada. It is also available in generic
> formulations. In Canada, regulatory authorities have approved taking daily
> PrEP for people at high risk of HIV infection. However, some doctors
> prescribe intermittent PrEP (so-called “on-demand”) to gay, bisexual and
> other men who have sex with men (MSM), as clinical trials have found that
> this schedule also reduces the risk of HIV infection in this group. PrEP
> also involves regular screening for HIV and other sexually transmitted
> infections (STIs), as well as other assessments, done prior to starting
> PrEP and usually every three months thereafter.
>
> A problem that has emerged both in clinical trials and in clinics is that
> some people have difficultly remembering to take PrEP exactly as directed,
> maintaining regular visits to their healthcare providers and going for lab
> tests.
>
> In the United States, research has found that young gay, bisexual and
> other men who have sex with men (MSM) are at heightened risk for HIV
> infection. Furthermore, at least two studies with adolescents and young men
> in that country have found reduced rates of adherence to PrEP. In an
> attempt to find ways to improve the ability of youth to take PrEP exactly
> as directed (and thereby maintain protection from HIV), researchers in San
> Francisco and Chicago have developed an intervention that works on mobile
> telephones. The intervention, code-named PrEPmate, centres on text messages
> that can be sent between healthcare professionals and PrEP users.
> Researchers tested it in a randomized clinical trial with young men living
> in Chicago. They found that PrEPmate users were significantly more likely
> to maintain timely medical appointments and have high levels of tenofovir
> DF in their blood than participants who did not use PrEPmate.
> The premise for PrEPmate
>
> The idea for PrEPmate was based on Canadian adherence research. About a
> decade ago, Canadian scientists developed a pill-taking reminder using a
> simple text message for mobile telephones for use by HIV-positive people in
> East Africa. This was tested in a randomized clinical trial in Kenya among
> people taking HIV treatment (ART) and was found to help improve the ability
> of people to achieve and maintain a suppressed viral load.
>
> Subsequently, researchers in San Francisco developed PrEPmate based on the
> Kenyan study as well as data from PrEP users in a pilot study.
>
> According to the developers of PrEPmate, the intervention is “grounded in
> the information, motivation and behavioural theory of behaviour change.”
> PrEPmate includes text messages and an online presence, all designed to
> enhance adherence to PrEP among young MSM. The program sent out “check-in”
> messages as well as daily reminders about pill-taking accompanied by what
> the researchers called “fun facts and trivia.” The daily reminders were
> sent out for the first two weeks after participants initiated PrEP, “with
> the option to continue to receive reminders throughout the study.”
> Pill-taking reminders were sent at a time chosen by the participants.
>
> Participants using PrEPmate who sought support from the study staff were
> contacted by text or telephone. The online component of PrEPmate included
> information about PrEP as well as videos by young people who had taken PrEP
> outside of the study. The researchers stated that there was also a
> password-protected user forum that was moderated by staff where
> participants could “discuss PrEP-related issues with other participants
> using PrEPmate.”
>
> PrEPmate was compared to the standard of care associated with PrEP-taking,
> which researchers stated has the following components:
>
>    - “HIV risk assessment”
>    - “brief adherence and risk reduction counselling”
>    - “clinical evaluation and medical management”
>    - “access to a pager to reach a clinician whenever needed”
>    - viewing a video “explaining how PrEP works in the body”
>    - “receiving reminders for clinic visits via phone calls per the local
>    clinic standard”
>
> Researchers excluded volunteers who could not commit to the regular clinic
> and laboratory visits that are needed to accompany the use of PrEP.
> Study details
>
> Participants were randomized in a 2:1 ratio to receive either PrEPmate (81
> men) or the standard of care (40 men) for 36 weeks. All participants
> received free PrEP from the study clinic. To try to simulate conditions in
> the world outside of a clinical trial, participants still had to pay for
> clinic visits and laboratory services.
>
> The average profile of participants upon entering the study was as follows:
>
>    - age – 24 years
>    - 95% identified as male and the remaining participants identified as
>    “transgender or gender queer”
>    - major ethno-racial groups: 36% Hispanic, 28% Black, 26% white
>    - 73% disclosed problematic levels of drinking
>    - 21% tested positive for chlamydia, gonorrhea or syphilis
>    - symptoms of depression were relatively common among all
>    participants; after randomization, such symptoms were found in 40% of
>    participants who were assigned to receive PrEP and 22% of participants who
>    were assigned to receive the standard of care
>
> Results
>
> Overall, researchers found that participants who used PrEPmate compared to
> people who used the standard of care were significantly more likely to have
> the following:
>
>    - completed more of the required clinic visits –  86% vs. 71%
>    - high protective concentrations of tenofovir in their blood – 72% vs.
>    57%
>
> These differences remained significant after researchers took into account
> whether or not a person had symptoms of depression. Furthermore, factors
> such as race/ethnicity, income, education level and having private
> insurance coverage had no impact on the study’s results.
>
> Although these results are very encouraging, toward the end of the study
> (around week 36) the researchers found the following disappointing trends:
> More participants from both study groups missed clinic visits and “only 57%
> of PrEPmate participants had protective tenofovir [levels in their blood],
> suggesting that additional efforts may be required to sustain long-term
> adherence.”
> Adverse events
>
> The unfortunate events that can occur in a clinical trial are called
> “adverse events” by researchers. These can be caused by study drugs,
> pre-existing health problems or other issues such as accidents. In the
> present study, only one serious adverse event occurred: One young man
> developed severe depression and thoughts of suicide. He was in the standard
> of care group. Although investigation revealed that his illness was not
> caused by the study drugs, his doctor removed him from the study so that
> his depression could be treated.
> Sexually transmitted infections
>
> No participants developed HIV infection.
>
> Over the course of the study, researchers found that rates of other STIs
> fell among participants.
> Views and use of PrEPmate
>
> Researchers surveyed participants who used PrEPmate and found that it was
> viewed favourably, as follows:
>
>    - 88% reported that it was “very/somewhat helpful”
>    - 83% reported that they wanted to continue using PrEPmate after the
>    study ended
>    - 92% would recommend PrEPmate to other people
>
> The majority (61%) of requests for assistance via PrEPmate during the
> study were for help securing clinic appointments. Only 14% of requests were
> for counselling and the remainder of requests were for a wide variety of
> issues.
> Bear in mind
>
> Adherence is a problem for many people who have to take medicines daily,
> whether because of high blood pressure, abnormal cholesterol, type 2
> diabetes or the treatment or prevention of HIV infection, and there is no
> simple and perfect adherence support intervention. In this context, the
> development and testing of an adherence and support tool such as PrEPmate
> is useful. This multi-component smartphone intervention was found to be
> generally effective at keeping a majority of young participants engaged in
> medication-taking and regular clinic visits. PrEPmate is a good step
> forward in helping to maintain adherence to Truvada, at least over the
> short term. However, given the decrease in adherence over the long-term,
> PrEPmate likely requires further refinement.
>
> Smartphones are widely used, particularly by young people. Therefore, it
> is likely that there will be an increased focus on adherence interventions
> that involve smartphones for PrEP in the future.
>
> *Resources*
>
> Oral pre-exposure prophylaxis (PrEP)
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=0c907ba29a&e=0f7b6f861c>
> – Fact sheet
>
> CATIE statement on the use of oral pre-exposure prophylaxis (PrEP) as a
> highly effective strategy to prevent the sexual transmission of HIV
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=5f28c1c73d&e=0f7b6f861c>
>
> Canadian guidelines on HIV pre-exposure prophylaxis and nonoccupational
> postexposure prophylaxis
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=f6685a537f&e=0f7b6f861c>
> – Biomedical HIV Prevention Working Group of the CIHR Canadian HIV Trials
> Network (CTN)
>
> La prophylaxie préexposition au virus de l'immunodéficience humaine :
> Guide pour les professionnels de la santé du Québec
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=516d5049cc&e=0f7b6f861c> –
> Ministère de la Santé et des Services sociaux du Québec (French only)
>
> Guidance for the use of Pre-Exposure Prophylaxis (PrEP) for the prevention
> of HIV acquisition in British Columbia
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=8dc2b30495&e=0f7b6f861c>
>  – B.C. Centre for Excellence in HIV/AIDS
>
> 8 Questions About PrEP for Guys
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=e65b648351&e=0f7b6f861c>
> – Client resource available online and in print
>
> PrEP for understudied populations: Exploring questions about efficacy and
> safety
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=947208c9ae&e=0f7b6f861c>
> – *Prevention in Focus*
>
> mHealth (mobile health)
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=eba783baaf&e=0f7b6f861c>
> – mobile health intervention resources in *Programming Connection*
>
> Pre-exposure prophylaxis (PrEP) resources
> <https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=daed9f74ed&e=0f7b6f861c>
>
> *—Sean R. Hosein*
>
> REFERENCES:
>
>    1. Liu AY, Vittinghoff E, von Felten P, et al. Randomized controlled
>    trial of a mobile health intervention to promote retention and adherence to
>    pre-exposure prophylaxis among young people at risk for human
>    immunodeficiency virus: The EPIC study. *Clinical Infectious Diseases*.
>    2018; *in press*.
>    2. Holloway IW, Dougherty R, Gildner J, et al. Brief Report: PrEP
>    uptake, adherence, and discontinuation among California YMSM using
>    geosocial networking applications. *Journal of Acquired Immune
>    Deficiency Syndromes*. 2017 Jan 1;74(1):15-20.
>    3. Hosek SG, Rudy B, Landovitz R, et al. An HIV pre-exposure
>    prophylaxis demonstration project and safety study for young MSM. *Journal
>    of Acquired Immune Deficiency Syndromes*. 2017 Jan 1;74(1):21-29.
>    4. Hosek SG, Landovitz RJ, Kapogiannis B, et al. Safety and
>    feasibility of antiretroviral pre-exposure prophylaxis for adolescent men
>    who have sex with men aged 15 to 17 years in the United States. *JAMA
>    Pediatrics.* 2017 Nov 1;171(11):1063-1071.
>    5. Lester RT, Ritvo P, Mills EJ, et al. Effects of a mobile phone
>    short message service on antiretroviral treatment adherence in Kenya
>    (WelTel Kenya1): a randomised trial. *Lancet*. 2010 Nov
>    27;376(9755):1838-45.
>    6. Smillie K, Van Borek N, Abaki J, et al. A qualitative study
>    investigating the use of a mobile phone short message service designed to
>    improve HIV adherence and retention in care in Canada (WelTel BC1). *Journal
>    of the Association of Nurses in AIDS Care*. 2014 Nov-Dec;25(6):614-25.
>    7. van der Kop ML, Muhula S, Nagide PI, et al. Effect of an
>    interactive text-messaging service on patient retention during the first
>    year of HIV care in Kenya (WelTel Retain): an open-label, randomised
>    parallel-group study. *Lancet Public Health*. 2018 Mar;3(3):e143-e152.
>
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