Remote pre-exposure prophylaxis adherence monitoring among young, Black men who have sex with men: a feasibility and acceptability pilot study

Young, Black, gay and bisexual men who have sex with men (GBMSM) experience disproportionate HIV incidence and are a priority population for pre-exposure prophylaxis (PrEP). In addition to understanding barriers to PrEP initiation, it is imperative that we also understand patterns of adherence and persistence on PrEP among young, Black GBMSM who have started PrEP. Understanding factors associated with PrEP adherence and persistence will facilitate the development of interventions to encourage effective PrEP use. We conducted a study to examine the feasibility and acceptability of using frequent, online, self-administered surveys to assess recent sexual behavior and PrEP use over six months among young, Black GBMSM on PrEP. Participants completed brief surveys weekly for three months followed by monthly surveys through month six. They were also asked to submit a self-collected dried blood spot to provide a biological measure of PrEP adherence at months three and six. Feasibility was measured via completion percentages for the surveys and dried blood spot collection; acceptability was measured via qualitative data collected during in-depth interviews. Overall, 71% of participants completed at least 80% of study surveys and 64% returned at least one dried blood spot specimen. Most study procedures were reported to be acceptable, although some participants did have some difficulties using the study app to complete surveys. Short, frequent, self-administered surveys and self-collected dried blood spots were found to be feasible and acceptable methods to measure PrEP adherence and persistence among young, Black GBMSM and might form the basis for future adherence interventions.