A UCLA Health study found that a combination of one-on-one telehealth coaching interventions, peer support forums and automated text messages more than doubled the use of the HIV prevention strategy, called PrEP , among younger and at-risk Americans. a group that historically has had low use of the drug.
The results of randomized controlled trials, published in Lancet digital healthtested combinations of interventions to improve HIV prevention behaviors, including pre-exposure prophylaxis, or PrEP, among young Americans who have historically had the lowest rate of use of this drug among the 1.2 million of people in the United States, according to the Centers for Disease Control and Prevention. The CDC estimates would 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. The drug reduces the risk of HIV infection during sexual intercourse by 99% when taken as prescribed, according to the CDC.
It is estimated that among Americans aged 16 to 24, only 15% use PrEP, compared to a national average of 25% across all ages. Adoption is lowest among Black (8%) and Latino (14%) Americans, according to the CDC.
Dallas Swendeman, lead author of the study and professor in the UCLA Department of Psychiatry and Biobehavioral Sciences, said there are several factors behind this low usage, including medical distrust, affordability, access to health care, being on a parent’s insurance plan, discomfort discussing sexual activity. with doctors, substance abuse, and basic survival needs including housing, food, and income.
The two-year study recruited nearly 900 residents of Los Angeles and New Orleans who identified as young gay, bisexual, transgender or other sexual minorities. Approximately 40% of participants were Black, 29% Latino, 21% White, and 6% Asian or Pacific Islander.
Participants were randomly divided into four groups, each with different combinations of interventions, including automated text messages, private social media forums, and one-on-one strengths-based telehealth coaching by nearby paraprofessionals.
After the first eight months, the PrEP uptake rate among the group that received all three interventions increased from a baseline of 11% to over 20%, which was the highest among the four groups and s is maintained throughout the 24 months of follow-up.
The study authors said this increase, if implemented nationally, could help lower the curve of new HIV infections in the absence of other prevention strategies among young Americans. PrEP use in the other three study groups increased to about 15% after 8 months, but then declined.
“Science is developing biomedical innovations at an impressive pace, but getting people to use them is very difficult, as we have seen with COVID vaccines and as we are seeing with PrEP for HIV prevention,” Swendeman said. “We still need behavioral interventions and wraparound services to support people in their overall care to prioritize HIV prevention as well as the other competing needs and priorities they have in their lives.”
Additionally, researchers found in a separate analysis that participants assigned to the two study groups that included telehealth coaching remained more engaged in mental health and support services related to housing, food and economic security over time, compared to groups with only automated texting and online peer support. .
The study also investigated whether the interventions affected condom use; use of post-exposure prophylaxis (PEP), a medication used to prevent HIV infection after potential exposure; and partner numbers. Swendeman said no impacts have been observed in those areas.
Although the study results are promising, Swendeman said they need to be tested in more real-world settings before they can be scaled up. He is currently leading another federally funded implementation science study, in partnership with community organizations, to identify barriers, facilitators, and optimal implementation strategies for these interventions in real-world practice.
“We need to be more proactive about behavioral science and implementation to close the translational gaps between biomedical discoveries, their adoption and their impact,” Swendeman said.
More information:
Optimal Strategies to Improve Uptake and Adherence to HIV Prevention Among Youth at Risk for HIV in the United States (ATN 149): A Randomized, Controlled, Factorial Trial Lancet digital health (2024).
Provided by University of California, Los Angeles
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