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Pilot Randomized Controlled Trial of Game Plan for PrEP: A Brief, Web and Text Message Intervention to Help Sexual Minority Men Adhere to PrEP and Reduce Their Alcohol Use

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Abstract

Suboptimal adherence to oral PrEP medications, particularly among younger sexual minority men (SMM), continues to be a key barrier to achieving more substantial declines in new HIV infections. Although variety of interventions, including web and text-message-based applications, have successfully addressed PrEP adherence, very few have addressed the potential influence of alcohol. This pilot study explored whether the Game Plan for PrEP, a brief, web-based and text messaging intervention, helped promote PrEP persistence and adherence and reduced condomless sex and alcohol use. Seventy-three heavy-drinking SMM on PrEP were recruited online from states with Ending the HIV Epidemic jurisdictions and randomly assigned 1:1 to receive either the Game Plan for PrEP intervention or an attention-matched control. We collected online surveys assessing primary outcomes at one, three, and six months post-enrollment. As secondary outcomes, we also collected dried blood spot samples at baseline, three, and six months to analyze for biomarkers of PrEP and alcohol use. Our results showed that the odds of stopping PrEP or experiencing a clinically meaningful lapse in PrEP adherence (≥ 4 consecutive missed doses) were not different across the two conditions. We also did not find evidence of any differences in condomless sex or drinking outcomes across conditions, although participants in both conditions reported drinking less often over time. These findings were consistent across both self-reported outcomes and biomarkers. Overall, we did not find evidence that our brief, web and text messaging intervention encouraged more optimal PrEP coverage or moderate their alcohol use.

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Funding

This manuscript was supported by R34AA027195, P01AA019072 from the National Institute on Alcohol Abuse and Alcoholism and P30AI042853 from the National Institute of Allergy and Infectious Diseases.

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Authors and Affiliations

  1. Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA

    Tyler B. Wray, Christopher W. Kahler, Erik M. S. Ocean & Vasileios Nittas

  2. Department of Medicine, Brown University, Providence, RI, USA

    Philip A. Chan

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Contributions

Conceptualization: Tyler B. Wray, Phil (A) Chan, Christopher W. Kahler, Erik M.S. Ocean; Methodology: Tyler (B) Wray, Phil (A) Chan, Christopher W. Kahler, Erik M.S. Ocean; Formal analysis and investigation: Tyler (B) Wray, Christopher W. Kahler; Writing - original draft preparation: Tyler B. Wray, Vasileios Nittas; Writing - review and editing: Tyler B. Wray, Vasileios Nittas, Christopher W. Kahler, Phil (A) Chan, Erik M.S. Ocean; Funding acquisition: Tyler (B) Wray, Phil A. Chan, Christopher W. Kahler.

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Correspondence to Tyler B. Wray.

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Wray, T.B., Chan, P.A., Kahler, C.W. et al. Pilot Randomized Controlled Trial of Game Plan for PrEP: A Brief, Web and Text Message Intervention to Help Sexual Minority Men Adhere to PrEP and Reduce Their Alcohol Use. AIDS Behav 28, 1356–1369 (2024). https://doi.org/10.1007/s10461-023-04223-9

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