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Design and Delivery of Real-Time Adherence Data to Men Who Have Sex with Men Using Antiretroviral Pre-exposure Prophylaxis via an Ingestible Electronic Sensor

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Abstract

Once daily tenofovir/emtricitabine when used for pre-exposure prophylaxis (PrEP) is effective in preventing HIV acquisition but requires consistent medication adherence. The use of ingestible technologies to monitor PrEP adherence can assist in understanding the impact of behavioral interventions. Digital pill systems (DPS) utilize an ingestible radiofrequency emitter integrated onto a gelatin capsule, which permits direct, real-time measurement of medication adherence. DPS monitoring may lead to discovery of nascent episodes of PrEP nonadherence and allow delivery of interventions that prevent the onset of sustained nonadherence. Yet, the acceptance and potential use of DPS in high-risk men who have sex with men (MSM; i.e., those who engage in condomless sex and use substances) is unknown. In this investigation, we conducted individual, semi-structured qualitative interviews with 30 MSM with self-reported non-alcohol substance use to understand their responses to the DPS, willingness and perceived barriers to its use, and their perceptions of its potential utility. We also sought to describe how MSM would potentially interact with a messaging system integrated into the DPS. We identified major themes around improved confidence of PrEP adherence patterns, safety of ingestible radiofrequency sensors, and design optimization of the DPS. They also expressed willingness to interact with messaging contingent on DPS recorded ingestion patterns. These data demonstrate that MSM who use substances find the DPS to be an acceptable method to measure and record PrEP adherence.

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Funding

PRC is funded by NIH K23DA044874, R44DA051106 and research funding from Gilead Sciences (ISR-17-1018), Hans and Mavis Psychosocial Foundation and e-ink corporation, KM and CO are funded by NIAID P30AI060354, EWB and RKR are funded by NIH R01DA047236.

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Authors and Affiliations

  1. Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA, 02411, USA

    Peter R. Chai & Edward W. Boyer

  2. The Fenway Institute, Fenway Health, Boston, MA, USA

    Peter R. Chai, Georgia Goodman, Majo Bustamante, Lizette Mendez, Yassir Mohamed, Kenneth H. Mayer, Edward W. Boyer & Conall O’Cleirigh

  3. Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA

    Peter R. Chai

  4. The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Boston, MA, USA

    Peter R. Chai

  5. Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

    Georgia Goodman & Conall O’Cleirigh

  6. Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA

    Kenneth H. Mayer

  7. Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA

    Rochelle K. Rosen

  8. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA

    Rochelle K. Rosen

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  1. Peter R. Chai
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Correspondence to Peter R. Chai.

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This study was funded through unrestricted research funds through the ISR program at Gilead Sciences.

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Chai, P.R., Goodman, G., Bustamante, M. et al. Design and Delivery of Real-Time Adherence Data to Men Who Have Sex with Men Using Antiretroviral Pre-exposure Prophylaxis via an Ingestible Electronic Sensor. AIDS Behav 25, 1661–1674 (2021). https://doi.org/10.1007/s10461-020-03082-y

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