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TEXT MESSAGING IS ASSOCIATED WITH IMPROVED RETENTION IN A CLINIC-BASED PREP PROGRAM
Christine M. Khosropour1, Richard T. Lester2, Matthew R. Golden1, Julia C. Dombrowski1
1Univ of Washington, Seattle, WA, USA,2Univ of British Columbia, Vancouver, British Columbia, Canada
Text messaging and short message service (SMS) interventions are associated with improved medication adherence among HIV-positive individuals. The impact of SMS on retention in a clinic-based pre-exposure prophylaxis (PrEP) program is unknown.
From September 2015 to June 2016 we invited all patients receiving PrEP through an STD clinic in Seattle, Washington to enroll in an SMS program (provided by WelTel) that included three components: automated weekly 'check-in' messages, automated appointment reminders, and bi-directional open communication via SMS with clinic staff. Per routine clinic practice, PrEP patients return to the clinic one month following enrollment and then every three months. Patients cease to receive PrEP from our clinic if they do not return to the clinic and do not respond to multiple phone calls or if they notify the clinic that they are discontinuing PrEP. We used chi-square tests to compare characteristics of patients who did and did not enroll in the SMS program and to examine differences in retention in the PrEP program among those did and did not enroll in SMS. We used log binomial regression to examine the adjusted relative risk (aRR) of the association between enrollment in SMS and dropping from our clinic's PrEP program.
There were 225 patients who received PrEP from our clinic during the study period. Most (95%) were men who have sex with men, 53% were white non-Hispanic and the average age was 31. Of 225 PrEP patients, 159 (71%) opted to enroll in the SMS program; 5 (3.1%) later requested to be withdrawn. Enrollment in SMS was highest for Asian patients (91.3% enrolled) and lowest for black patients (55.6% enrolled). Patients aged 16-24 years were more likely to enroll in SMS compared to those >25 years (82.5% vs. 66.5%, P=0.02). Overall, 70 men stopped receiving PrEP from our clinic during the study period, including 44 (27.7%) of 159 patients enrolled in SMS and 26 (39.9%) of 66 patients not enrolled in SMS (P=0.08). Adjusting for age, race/ethnicity and gender, patients enrolled in SMS were 34% less likely to discontinue PrEP from our clinic compared to those who were not enrolled (aRR=0.66; 95% confidence interval=0.45-0.97).
Among PrEP patients in our STD clinic, the majority opted to receive SMS messages and those who did were less likely to discontinue PrEP. These findings suggest that implementing SMS as part of PrEP clinical care is acceptable and may improve retention.