Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Sep;23 Suppl 5(Suppl 5):e25564.
doi: 10.1002/jia2.25564.

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

Wipaporn Natalie Songtaweesin  1 , Surinda Kawichai  1 , Nittaya Phanuphak  2 , Tim R Cressey  3   4   5 , Prissana Wongharn  1 , Chutima Saisaengjan  1 , Tanat Chinbunchorn  2 , Surang Janyam  6 , Danai Linjongrat  7 , Thanyawee Puthanakit  1   8 ; CE-PID - TRC Adolescent Study Team
Collaborators, Affiliations
Randomized Controlled Trial

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

Wipaporn Natalie Songtaweesin et al. J Int AIDS Soc. 2020 Sep.

Abstract

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."

Trial registration: ClinicalTrials.gov NCT03778892.

Keywords: HIV prevention; adolescents; men who have sex with men (MSM); pre-exposure prophylaxis (PrEP) adherence; transgender women (TGW).

PubMed Disclaimer

Figures

Figure 1
Figure 1
Adherence to once daily oral HIV pre‐exposure 3 prophylaxis at months 3 and 6 of follow‐up by randomization arm. YFS, Youth‐friendly services; YFS + APP, Youth‐friendly services plus mobile phone application use.
Figure 2
Figure 2
Mode of protection of risk periods against HIV and STIs seen in Thai adolescents. “PrEP protection” defined as ≥700 fmol/punch, “condom protection” defined as 100% condom use. PrEP, pre‐exposure prophylaxis; STIs, sexually transmitted infections.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. van Griensven F, Guadamuz Thomas E, de Lind van Wijngaarden JW, Phanuphak N, Solomon SS, Lo Y‐R. Challenges and emerging opportunities for the HIV prevention, treatment and care cascade in men who have sex with men in Asia Pacific. Sex Transmit Infect. 2017;93(5):356–62. - PubMed
    1. Baral SD, Grosso A, Holland C, Papworth E. The epidemiology of HIV among men who have sex with men in countries with generalized HIV epidemics. Curr Opin HIV AIDS. 2014;9(2):156–67. - PubMed
    1. van Griensven F, Thienkrua W, McNicholl J, Wimonsate W, Chaikummao S, Chonwattana W, et al. Evidence of an explosive epidemic of HIV infection in a cohort of men who have sex with men in Thailand. AIDS. 2013;27(5):825–32. - PubMed
    1. Thienkrua W, van Griensven F, Mock PA, Dunne EF, Raengsakulrach B, Wimonsate W, et al. Young men who have sex with men at high risk for HIV, Bangkok MSM Cohort Study, Thailand 2006–2014. AIDS Behav. 2018;22(7):2137–46. - PMC - PubMed
    1. van Griensven F, Varangrat A, Wimonsate W, Tanpradech S, Kladsawad K, Chemnasiri T, et al. Trends in HIV prevalence, estimated hiv incidence, and risk behavior among men who have sex with men in Bangkok, Thailand, 2003–2007. J Acquir Immune Defic Syndr. 2010;53(2):234–9. - PubMed

Publication types

Associated data