JMIR Publications

ABSTRACT

Background:

HIV testing is the gateway to the HIV prevention continuum and offers an important opportunity to offer HIV prevention services. TakeMeHome.org is an online program enabling state and local health departments to offer free in-home HIV/STI self-testing. As few TakeMeHome users have used PrEP, there is an opportunity of linking TakeMeHome users to PrEP information and services.

Objective:

The aim of this study is to develop a strategy to link HIV/STI self-testers from online order to PrEP services via direct digital linkage to a novel SMS navigation program.

Methods:

: PrEPmate is an evidence-based bi-directional text-messaging platform that has demonstrated increased PrEP retention and adherence. We developed a novel program of linking TakeMeHome testers to mobile SMS PrEP navigation via PrEPmate. We conducted focus groups among TakeMeHome users to elicit preferences for linkage from TakeMeHome to PrEPmate. Through these focus groups, we revised content and functionality for this linkage intervention. In October 2023, we launched a pilot in two US Ending the HIV Epidemic (EHE) jurisdictions: Sacramento, California and Tarrant, Texas.

Results:

13 TakeMeHome users participated in four focus groups (mean age 31.5; 31% Latinx, 15% Black; 69% never used PrEP). When shown wireframes of the TakeMeHome/PrEPmate linkage, most thought they were easy to navigate and user-friendly. They liked the privacy of connecting with a PrEP navigator using SMS. Participants recommended providing a clear description of PrEP and PrEPmate’s services and indicating PrEP is low/no-cost on the TakeMeHome website. On the PrEPmate landing page, they recommended adding language on confidentiality and the partnership with TakeMeHome to show both services are connected. Once enrolled, they recommended weekly/bi-weekly check-ins to assist with PrEP navigation. Overall, 92% of FG participants were likely to use PrEPmate to learn more about PrEP and/or link to PrEP services. From October 2023 to May 2024, among 537 individuals who ordered test kits and were not on PrEP, 169 (31%) were linked to PrEPmate page, and 86 (16%) enrolled in PrEPmate. PrEP navigation has been provided via SMS/phone, with 46 (53%) provided PrEP education and 26 (30%) in various stages of starting PrEP. In exit interviews, participants found the intervention easy to use and appreciated being connected with an experienced PrEP navigator who helped them get access to PrEP.

Conclusions:

Through user-centered design, we successfully developed a program to link TakeMeHome testers to PrEP navigation via PrEPmate, with high feasibility and acceptability of the intervention and a substantial number of clients starting PrEP. Next steps will be to evaluate the effectiveness of this program on a larger scale, and if successful, expand PrEPmate navigation to all EHE jurisdictions using TakeMeHome.