Could combined support be the key to increasing PrEP use among young people?

Research in the USA suggests that a combination of text messages, peer support and motivational coaching helped different groups of young people keep taking PrEP. 

What is the research about? 

The impact of automated text messages, online peer support and coaching to improve HIV prevention practices among adolescents and young people (ages 16–24) in Los Angeles and New Orleans, USA. 

The study examined PrEP uptake and adherence, PEP uptake and adherence, condom use and reducing the numbers of sexual partners. The study involved around 900 racially and ethnically diverse young people. All identified as gay, bisexual, transgender, a man who has sex with men, gender diverse, non-binary or queer. More than a third had been homeless and a sixth had been in prison.  

Participants were randomly assigned to one of four groups and were followed for 24 months. The first group got daily automated informational, motivational and reminder text messages. The messages covered physical health and healthcare, mental health and wellness, sexual health, substance use, and PrEP or PEP medication reminders (if applicable). A weekly HIV prevention ‘check-in’ survey was also sent.  

The second group had the text service plus peer support via private social media. The third group had the text messages plus strengths-based, goal orientated telephone, online and offline coaching, delivered by trained peers. The fourth group had the text messages, plus peer support and the coaching.  

Why is this research important? 

Adolescents and young people are disproportionately affected by HIV. Of all HIV infections in over 15s in 2022, 30% were among adolescents and young people. In sub-Saharan Africa, adolescent girls and young women are particularly at risk. In other parts of the world, most young people who get HIV belong to a high-risk group, such as people who inject drugs, sex workers or LGBT+ people.  

What did they find out? 

At the beginning of the study, 66% of participants reported anal sex without a condom in the past 12 months.  

Around one in ten (11%) were using PrEP at the study’s start. After four months, this had increased to 15%. This was in line with national PrEP use among young people.  

In the group that received the full intervention (text messages, online peer support and coaching), PrEP use continued to increase. At eight months it had reached over 20%. This was sustained throughout the two-year study. This is similar to PrEP coverage among at-risk adults in the USA, which is around 24%. 

But the intervention did not affect condom use or PEP use. And it did not reduce the number of sexual partners that participants had. 

Participation in the intervention was mixed. Around three-quarters of young people consistently engaged with the text messages, and more than half participated in coaching. But only a quarter participated in peer support. 

What does this mean for HIV services? 

This study shows that a combination of support can improve PrEP uptake. The support was mainly provided online and through telephone contact but coaching peers offline was also offered.  

Peer support provides opportunities for young people to share their experiences and ask questions. This can help to demystify and normalise PrEP use. Coaching provides young people support with goal setting and problem solving skills. It can also makes them take accountability by following through on their agreements to access PrEP services and stick to other health and well-being goals. 

The fact that the full intervention did not affect condom use, sexual partner numbers and PEP use and adherence is interesting. More research is needed to understand the link between young people’s prevention choices and risk behaviours.  

Dallas Swendeman, lead author on the study, said: “[We] need behavioural interventions and wraparound services to support people in their whole person care, to prioritize HIV prevention as well as the other competing needs and priorities they have in their lives.”