Editor's Note: Numerous studies have explored the use of long-acting antiretroviral therapy (Long-acting ART) for HIV pre-exposure prophylaxis (PrEP), achieving positive preventive outcomes. However, the promotion of long-acting PrEP still faces many challenges. Additionally, how can adherence to existing oral PrEP regimens be further improved? At the recently held 9th Asia Pacific AIDS & Co-infections Conference (APACC 2024), Dr. Chunyan Li from the The University of Tokyo Institutes for Advanced Study participated in several panel discussions and shared her team's research findings, offering more insights and reflections on these issues.Infectious Diseases Frontier: What role do you think long-acting ART will play in future HIV prevention?
Dr. Chunyan Li: Long-acting antiretroviral therapy (Long-acting ART) is not only an effective treatment for people living with HIV but also a powerful preventive tool. Recent clinical trial results (PURPOSE 1) revealed by companies show that long-acting ART (Lenacapavir) achieved a 100% effectiveness rate in preventing HIV among adolescent and young women. This finding can significantly reduce clinical follow-up frequency and ease the burden on healthcare workers. For individuals at risk of HIV and those needing PrEP, long-acting ART means they do not need to visit medical institutions frequently to get their medication, and they can also avoid the psychological and behavioral burdens associated with daily medication. Psychologically and behaviorally, this reduces unnecessary hassle and burden. However, in the short term, the economic cost of the drug is a major challenge, as even the current oral PrEP costs are not affordable for everyone. We need health policymakers and researchers to adopt smarter funding strategies to ensure that long-acting ART or PrEP can be conveniently and affordably accessible to everyone in need.
Infectious Diseases Frontier: What are your views on using innovative digital means to enhance HIV prevention?
Dr. Chunyan Li: In the current trend of mobile health and e-health, I firmly believe it has become a focus of public attention. Almost everyone, regardless of age or economic condition, relies on mobile phones and the internet. Therefore, disseminating health intervention information related to HIV prevention and treatment through e-health or mobile internet platforms is undoubtedly an efficient and cost-effective approach. However, as public health workers, we currently face the challenge of ensuring these mobile health interventions are not only effective in achieving our desired outcomes but also user-friendly and engaging enough to encourage continuous use.
In the current environment dominated by short videos and social media, people are easily attracted by transient trends. However, ensuring the sustained effectiveness of public health interventions requires further research and theoretical support. In designing mobile health behavior interventions, the involvement of the community is as important as the leadership of researchers. Listening to the interests and needs of users and incorporating their feedback into the design, implementation, and evaluation of interventions is key to ensuring that these interventions truly meet people’s needs. This approach empowers individuals to take control of their health and well-being.
Enhancing PrEP Adherence Among MSM in China Through Co-Created Digital Interventions
During the APACC conference, Dr. Chunyan Li presented a stepped-wedge trial aimed at evaluating the effectiveness of a co-created, mobile-based PrEP adherence intervention among men who have sex with men (MSM) in China. This trial is part of a larger multicenter PrEP study conducted in Guangzhou and Wuhan (NCT04754139).
Participants in the study received 12 months of TDF/FTC treatment and were randomly assigned to four stepped-wedge intervention groups. Each group received PrEP adherence information interventions via the WeChat messaging app in a staggered quarterly sequence. The intervention content, co-created with PrEP users, included short videos, images, and infographics.
From July 2021 to December 2023, 910 MSM participants completed at least one follow-up survey, with an average age of 28.4 years. Approximately 24.2% were university students, and 64.1% had two or more sexual partners in the past three months. Around 25% of participants were lost to follow-up within 12 months, but the loss rate did not significantly differ between the intervention groups. Throughout the trial, about 60% of participants reported near-perfect adherence to PrEP, with no significant decline over time.
Regarding the intervention’s effectiveness, co-created PrEP adherence information slightly improved adherence levels (adjusted odds ratio [aOR] 1.07, 95% CI: 0.82-1.40), although the statistical significance was not achieved. Subgroup analysis indicated that on-demand PrEP users (55%) were less likely to report optimal adherence compared to daily PrEP users (45%) (aOR 0.79, 95% CI: 0.59-0.99). Younger or higher-income participants were more likely to report optimal adherence.
The study results suggest that co-created PrEP adherence interventions can enhance adherence and community engagement. The findings also highlight significant differences in adherence behaviors across different demographic groups, underscoring the importance of tailored and differentiated PrEP adherence interventions for various populations.
