Teens and young adults often don't use HIV-prevention medications known as PrEP, even when they could benefit from these drugs. But a few simple strategies, including telehealth coaching appointments and automated text messages, can dramatically boost usage in this group, a new study finds.
The nearly 900 young people in the trial were split into four groups, with one group getting only text messages, two receiving texts and one additional intervention each, and a final group getting a trio of interventions. This last group — who received text messages, coaching and access to an online support group of peers — doubled their use of PrEP, from 10% to 20%. If mirrored nationally, this rate would bring young people's PrEP coverage more in line with that of U.S. adults indicated for the medications.
The three interventions all provided information about PrEP and connected participants with services to help pay for the medications. But beyond that, they aimed to help the young people handle stressors in other aspects of their lives.
"We've known for decades now that HIV prevention is not a high priority for many people struggling with daily survival needs, other mental or physical health priorities, or other priorities in their lives," said Dallas Swendeman, lead author of the report and a behavioral scientist at UCLA's Center for HIV Identification, Prevention, and Treatment Services.
The researchers wanted to support participants through all these other challenges in their lives so that they'd be able to better prioritize HIV prevention, Swendeman told Live Science in an email.
Related: We could end the AIDS epidemic in less than a decade. Here's how.
The trial's results, published Wednesday (Feb. 21) in the journal The Lancet Digital Health, are now guiding Swendeman and his colleagues' efforts to roll out these treatments on a larger scale.
How to get more young people to use PrEP
PrEP is available as daily pills and as long-acting injections, and both treatment options are about 99% effective at preventing the spread of HIV via sex when used as prescribed, according to the Centers for Disease Control and Prevention (CDC). However, while PrEP is extremely effective, only about 30% of the estimated 1.2 million people at heightened risk of HIV were prescribed them in 2021, CDC data suggest.
To find ways of boosting PrEP use among young people, Swendeman and colleagues recruited hundreds of teens and young adults ages 12 to 24 in Los Angeles and New Orleans. The trial focused on gay and bisexual men and other men who have sex with men, as well as on transgender and gender-diverse people, as more than 80% of young people with HIV in the U.S. belong to these categories.
The participants were recruited through adolescent health clinics and community organizations for vulnerable youth, such as those in the LGBT community, those with housing insecurity and those who were previously incarcerated. They also recruited through social venues, like clubs; and via apps, like Grindr. Black and African American people made up about 40% of the study participants, followed by Latinx and Hispanic people (29%), white people (21%), and Asian and Pacific Islander people (6%).
The texts relayed information or motivational messages on physical health, substance use, mental health and wellness. The researchers also sent text medication reminders, if applicable. For example, one text might have read, "Friends can be good medicine. If you need to talk, give a friend a call" and another, "Going out of town? Don’t forget to pack your meds." Others provided links to explore health insurance options or to learn about people's personal experiences with PrEP.
The peer-support groups enabled young people to chat about topics ranging from current events and pop culture to mental health and jobs. They were also safe spaces for participants to ask questions about PrEP, share experiences and raise concerns.
Normalizing the use of PrEP can encourage young people to try the medications, Swendeman noted.
Finally, participants received coaching from people whose backgrounds closely matched their own. Coaches started by interviewing the participants to identify strengths and challenges in their daily lives. From there, they directed the participants to relevant services and helped them set and troubleshoot personal goals, with at least one centered on HIV prevention.
The group that received all three interventions roughly doubled their PrEP use within eight months of the trial's start. That rate stayed fairly steady for the following 16 months of the two-year study. In comparison, the other three groups saw smaller bumps in PrEP use — up to about 15% — that then wavered and fell again over time.
The strategies are designed to be flexible — either used in tandem or customized to a given person's needs.
As follow-up work, the team is looking into using chatbots to scale up the effort. For instance, bots could make the automated texts more personalized and interactive, as well as help automate aspects of monitoring the support group, Swendeman said. And with the release of technologies like ChatGPT, such automations could now be within reach, he said.
"It's a very exciting time," but there's still work to do to ensure chatbots deliver accurate information and are used as a tool to improve a person's care, rather than being used as a total replacement for a human clinician or coach, he said.
This article is for informational purposes only and is not meant to offer medical advice.
