Testing an electronic PrEP initiation and maintenance home care system to promote PrEP among adolescent MSM in rural and small town areas
Protocol Overview
ePrEP was a home-care system for PrEP that allowed rural MSM to initiate and maintain PrEP clinical care without requiring travel to a clinician office or to a laboratory for testing. ePrEP combined a home care system for behavioral surveillance and home specimen collection/shipping for laboratory tests with app-based telemedicine and patient management.
Principal Investigators:
Aaron Siegler, PhD, MHS | Emory University
ClinicalTrials.gov Number: NCT03729570
Duration
Participants remained in the study for 12 months after randomization.
Sample Size
240 (120 intervention, 120 control).
Eligibility
- Assigned male at birth
- Age 18-29 (inclusive)
- Live in Alabama, Georgia, Mississippi or North Carolina
- Laboratory confirmed HIV negative
- Owns an iOS or Android smartphone capable of running the study app
- Behaviorally indicated for PrEP
- History of inconsistent or no condom use with more than one partner
- History of inconsistent or no condom use with one partner who is not mutually monogamous
- Any STI diagnosed in past 6 months
- Commercial sex work
- African American MSM reporting anal sex in the past 6 months
- Clinician discretion based on epidemiologic context of HIV risk
- Willing to take daily FDA-approved daily oral PrEP
- Willing to use study-provided PrEP navigation services
- Willing to self-collect specimens
- Full list of eligibility and exclusion criteria available on ClinicalTrials.gov
Outcomes
The primary outcome is protective levels of PrEP, as indicated by TFV-DP levels. The cutpoint used for the primary outcome measure will be TFV-DP levels considered to be a surrogate for substantial protection: >700 fmol/punch, a level indicating > 4 doses/week. Secondary outcomes will include retention in PrEP care and a number of ATN harmonized measures. We will employ standard methods of cost analyses to estimate the cost, cost-effectiveness, and cost-utility of the intervention relative to standard of care.
Publications
- Siegler AJ, Mehta CC, Mouhanna F, Giler RM, Castel A, Pembleton E, Jaggi C, Jones J, Kramer MR, McGuinness P, McCallister S, Sullivan PS. Policy- and county-level associations with HIV pre-exposure prophylaxis use, the United States, 2018. Ann Epidemiol. 2020 May;45:24-31.e3. doi: 10.1016/j.annepidem.2020.03.013. Epub 2020 Apr 3. PubMed PMID: 32336655; PubMed Central PMCID: PMC7246022.
- Siegler AJ, Wiatrek S, Mouhanna F, Amico KR, Dominguez K, Jones J, Patel RR, Mena LA, Mayer KH. Validation of the HIV Pre-exposure Prophylaxis Stigma Scale: Performance of Likert and Semantic Differential Scale Versions. AIDS Behav. 2020 Sep;24(9):2637-2649. doi: 10.1007/s10461-020-02820-6. PubMed PMID: 32157490; PubMed Central PMCID: PMC7423865.
- Siegler AJ, Knox J, Bauermeister JA, Golinkoff J, Hightow-Weidman L, Scott H. Mobile app development in health research: pitfalls and solutions. 2021;7:32. doi: 10.21037/mhealth-19-263. eCollection 2021. Review. PubMed PMID: 33898601; PubMed Central PMCID: PMC8063010.
- Siegler AJ. Preexposure Prophylaxis Indication Criteria Underidentify Black and Latinx Persons and Require Revision. Am J Public Health. 2020 Mar;110(3):267-268. doi: 10.2105/AJPH.2019.305514. PubMed PMID: 32023104; PubMed Central PMCID: PMC7002926.
- Siegler AJ. Needed: A Life Course Perspective on Maintaining PrEP Use. Clin Infect Dis. 2020 Jan 14;. doi: 10.1093/cid/ciaa040. [Epub ahead of print] PubMed PMID: 31942945.
- Siegler AJ, Bratcher A, Weiss KM. Siegler et al. Respond. Am J Public Health. 2020 Jan;110(1):e3-e4. doi: 10.2105/AJPH.2019.305402. PubMed PMID: 31800291; PubMed Central PMCID: PMC6893340.
- Siegler AJ, Brock JB, Hurt CB, Ahlschlager L, Dominguez K, Kelley C, Jenness S, Wilde G, Jameson S, Bailey-Herring G, Mena LA. An Electronic Pre-Exposure Prophylaxis Initiation and Maintenance Home Care System for Nonurban Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019;8(6) e13982. DOI: 10.2196/13982 PMID: 31199326
- Steehler K, Siegler AJ. Bringing HIV Self-Testing to Scale in the United States: A Review of Challenges, Potential Solutions, and Future Opportunities. J Clin Microbiol. 2019 Nov;57(11). doi: 10.1128/JCM.00257-19. Print 2019 Nov. Review. PubMed PMID: 31462549; PubMed Central PMCID: PMC6813024.
- Sullivan PS, Mena L, Elopre L, Siegler AJ. Implementation Strategies to Increase PrEP Uptake in the South. Curr HIV/AIDS Rep. 2019 Aug;16(4):259-269. doi: 10.1007/s11904-019-00447-4. Review. PubMed PMID: 31177363; PubMed Central PMCID: PMC7117066.
- Siegler AJ, Bratcher A, Weiss KM. Geographic Access to Preexposure Prophylaxis Clinics Among Men Who Have Sex With Men in the United States. Am J Public Health. 2019 Sep;109(9):1216-1223. doi: 10.2105/AJPH.2019.305172. Epub 2019 Jul 18.
- Coy KC, Hazen RJ, Kirkham HS, Delpino A, Siegler AJ. Persistence on HIV preexposure prophylaxis medication over a 2-year period among a national sample of 7148 PrEP users, United States, 2015-2017. J Int AIDS Soc. 2019 Feb;22(2):e25252. doi: 10.1002/jia2.25252. PubMed PMID: 30775846; PubMed Central PMCID: PMC6378757.
- Siegler AJ, Bratcher A, Weiss KM, Mouhanna F, Ahlschlager L, Sullivan PS. Location location location: an exploration of disparities in access to publicly listed pre-exposure prophylaxis clinics in the United States. Ann Epidemiol. 2018 Dec;28(12):858-864. doi: 10.1016/j.annepidem.2018.05.006. Epub 2018 May 26.
- Sullivan PS, Siegler AJ. Getting pre-exposure prophylaxis (PrEP) to the people: opportunities, challenges, and emerging models of PrEP implementation. Sex Health. 2018 Nov;15(6):522-527. doi: 10.1071/SH18103.