Currently submitted to: JMIR Research Protocols
Date Submitted: May 13, 2020
Open Peer Review Period: May 13, 2020 - Jul 8, 2020
(currently open for review)
Online Navigation for Pre-exposure Prophylaxis for HIV Prevention via Chat: the PleasePrEPMe Chat Experience
Pre-exposure prophylaxis (PrEP) is an HIV medication taken by an HIV-negative individual to prevent infection before exposure to the virus. Numerous clinical studies in various communities have shown high rates of effectiveness when PrEP is taken as prescribed. Since FDA approval of the first product for PrEP in 2012, uptake has been lower than the estimated 1.1 million US adults who could benefit from its use, with an estimated 70,394 individuals on PrEP in 2017. Of these, only 11% are Black and 13% Hispanic, highlighting racial/ethnic disparities in PrEP uptake. Patient navigators have been shown to be effective in improving the linkage and retention in care outcomes of people living with HIV across the HIV treatment cascade, and can be used throughout the PrEP care continuum to assist decision making and connect potential users to PrEP services.
PleasePrEPMe Chat is a novel online strategy to improve engagement in PrEP care services with PrEP-eligible populations through an online navigation platform.
Visitors connected with navigators via online bilingual (English, Spanish) chat. During the chat, navigators helped locate PrEP services through the PleasePrEPMe provider directory, provided links to HIV-prevention resources, and supported uninsured, insured, and undocumented visitors with benefits navigation.
From launch to December 31, 2019, PleasePrEPMe completed 2,191 online chats. Average interaction time was 16 minutes, with chats often covering more than one topic (68%). Conversation topics included healthcare navigation (50%), provider identification (44%), PrEP information (35%), PEP information (15%), and the California PrEP Assistance Program (11%). Referrals to PrEP- or non-PrEP-related resources included: directory updates, HIV testing and treatment, undetectable = untransmittable or U=U, reproductive health, sexually transmitted infections, and other prevention methods. A total of 368 chat visitors completed a voluntary satisfaction scale rating the quality and helpfulness of the service provided, producing an average rating of 4.7 out of 5.
Online chat is a method for reaching people not already engaged in HIV-prevention services, supporting HIV-prevention decision making, and linking people seeking information online with in-person services. HIV-prevention conversations must necessarily include PrEP and PEP navigation to holistically serve the needs of visitors at all stages in the PrEP care continuum. Challenges around PrEP access include insurance and payment issues, confidentiality, and stigma. The nature of challenges seen in California may be different and not generalizable to states without Medicaid expansion or where the overall culture may be more politically conservative. Additional research evaluating online sexual health information services and understanding how social determinants of health influence online engagement are needed to better understand how to reach priority populations not well served by current HIV-prevention services.
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