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Telehealth for prescribing pre-exposure prophylaxis is safe, effective, and preferable for many young men who have sex with men and transgender women.
“PrEP is a well-proven mode of HIV prevention, with efficacy of over 99% when taken consistently,” Rebecca Braun, DrPH, MPH, notes. “However, the number of people who are on PrEP remains far too low, and significant inequities in PrEP access and utilization remain, particularly among young Black and Hispanic people. New approaches and avenues for getting PrEP into the hands of people who may be vulnerable to HIV infection are desperately needed.”
A primary barrier to PrEP uptake is access to the medication.
“The CDC has endorsed telehealth care as a key strategy for reaching the national goal of reducing new HIV infections by 90% by 2030,” she says. “While telehealth approaches to providing access to PrEP have been expanding, and there has been some prior research on this modality, there has never been a randomized controlled trial to establish how well telehealth works to make it easier for people to get and stay on PrEP.”
For a study published in JAIDS, Dr. Braun and colleagues conducted a randomized controlled trial of PrEPTECH, a telehealth intervention for the provision of PrEP, to examine the impact of telehealth on PrEP access. Young MSM and transgender women with an indication for PrEP were randomly assigned 1:1 to PrEPTECH or a control group, which involved access to an online listing of PrEP resources in their communities. The researchers examined self-reported PrEP initiation, use, and coverage between the control and intervention arms at 90 and 180 days of follow-up.
Telehealth for PrEP Safe and Effective
The study included 229 participants (mean age, 23.7). The sample was racially diverse, with 77.3% of individuals identifying as non-White, and more than half of participants (57.2%) lived in a home where a language other than English was spoken.
At 90 days, participants in the PrEPTECH arm had significantly higher postbaseline PrEP initiation than those in the control arm (OR, 6.63; 95% CI, 2.54-17.35), a difference that persisted at 180 days. The researchers reported no significant differences between groups regarding the number of sex acts for which participants were not protected by PrEP, adherence to PrEP, and recent PrEP use at 180 days postbaseline.
“Our findings show that the use of telehealth to provide PrEP is safe, effective, and preferable to many people, including—and importantly—young people of color,” Dr. Braun says. “The most notable finding from the PrEPTECH study was the dramatically higher PrEP uptake in our intervention group. This is particularly notable given the demographic included in our study: largely youth of color, over half of them in a household where a language other than English is spoken, and 62% without a bachelor’s degree. They have been particularly hard to reach with PrEP care.”
People provided access to PrEP via telehealth “were much, much more likely to get it, start it, and stay on it,” Dr. Braun continues (Table).
“Our primary outcome measure, PrEP initiation by 3 months post-enrollment, was over six times more likely among those in the PrEPTECH intervention compared with the online resources group. While PrEP initiation remained significantly more common by 180 days postbaseline, the difference between the control and intervention groups at the final time point regarding recent use of PrEP did not meet statistical significance. This suggests we need to do more to help PrEP telehealth users continue PrEP use over the long term.”
Increasing Telehealth to Improve PrEP Access
The findings indicate that scaling telehealth services could increase access to PrEP, Dr. Braun says.
“Given the disproportionately low uptake of PrEP in key populations in the United States, providers need to consider ways to remove obstacles to PrEP use,” she notes. “Our study suggests telehealth for PrEP can help dismantle these barriers. Clinicians who prescribe PrEP should consider offering PrEP telehealth services alongside clinic-based options, particularly those serving sexual and gender minority youth of color. Clinicians should also be aware of national telehealth providers and local entities that offer PrEP via telehealth, consider discussing these options, and refer interested patients.”
Future research, Dr. Braun continues, should determine the most appropriate candidates for PrEP telehealth and best practices for offering this type of care.
“In particular, future studies should pay special attention to improving PrEP persistence and adherence to support effective PrEP use. Ultimately, more investment in PrEP telehealth services is needed to widely increase availability and best optimize care to ensure widespread access to PrEP for HIV prevention.”
