Adapting effective mhealth interventions to improve uptake and adherence of the HIV pre- exposure prophylaxis (PrEP) in Thai young MSM

男男性行为青年（YMSM）是全球增长最快的艾滋病毒阳性人群。泰国 亚洲成人艾滋病毒血清阳性率最高;曼谷28.6%的男男性行为者艾滋病毒阳性。的 曼谷青年男男性行为者的艾滋病毒感染率为每100人年12.2例。有效的预防策略是 迫切需要防止艾滋病毒在这一高危人群中传播。暴露前预防（PrEP） 疾病预防控制中心和世卫组织建议的针对所有高危人群的有效艾滋病毒预防策略， 包括HIV阴性的男男性接触者当按规定服用时，PrEP是非常有效的，但PrEP的利用率一直很低。 低，坚持往往不够。为了解决泰国YMSM面临的这些挑战，我们建议制定 一种技术促进的干预措施，结合了PrEP摄取的动机增强系统和 坚持（MES-PrEP）和动机交互式文本消息（MTM），以增加吸收和 艾滋病毒阴性的泰国YMSM持续坚持PrEP。将对MTM进行编程和测试， 双向激励信息，以促进PrEP的吸收和遵守。我们的主要目标是发展和 试点测试MES-PrEP和MTM及相关协议，并评估初步证据的影响， 技术促进了干预。拟议的研究包括三个阶段。第一阶段包括深入 采访30名艾滋病毒阴性的泰国YMSM，探讨PrEP启动的障碍和促进因素， 坚持告知干预内容。第二阶段包括调整和beta测试MES-PrEP和MTM 使用10名HIV阴性泰国YMSM进行功能性和可行性研究。在第三阶段，我们将进行试点 随机对照试验，以评估MAS-PrEP的可行性、可接受性和初步疗效， MTM增加泰国YMSM中PrEP的吸收和坚持。我们将招募60名HIV阴性的泰国YMSM 没有开始PrEP和60 YMSM谁是PrEP，但不坚持它。参与者将 以2：1的比例随机接受MES-PrEP和MTM（n=40）或标准PrEP咨询（n=20）。可行性和 干预的可接受性将通过使用模式和系统可用性的对比来评估 规模初步影响将通过评估PrEP启动的比例和 参与者将在基线和术后1、3和6个月完成评估。 干预将收集遵守PrEP和HIV/STI的生物标志物。项目完成后，我们 我应该已经制定了一个高度创新的移动健康干预措施，以支持MSM使用PrEP，这将是准备好 进行更大规模的疗效试验

Young men having sex with men (YMSM) are the fastest growing HIV+ population worldwide. Thailand has the highest adult HIV seroprevalence in Asia; 28.6% of men having sex with men in Bangkok are HIV+. The HIV incidence rate among YMSM in Bangkok is 12.2 per 100 person-years. Effective prevention strategies are urgently needed to prevent HIV transmission in this high-risk population. Pre-exposure prophylaxis (PrEP) is an efficacious HIV prevention strategy recommended by the CDC and WHO for all at-risk individuals, including HIV-negative MSM. PrEP is highly effective when taken as prescribed, but PrEP utilization has been low and adherence is often inadequate. To address these challenges among Thai YMSM, we propose to develop a technology facilitated intervention combining Motivational Enhancement System for PrEP Uptake and Adherence (MES-PrEP) and Motivational Interactive Text Messaging (MTM) to increase uptake of and sustained adherence to PrEP among HIV-negative, Thai YMSM. MTM will be programmed and tested to send two-way motivational messages to promote PrEP uptake and adherence. Our primary aim is to develop and pilot test MES-PrEP and MTM and associated protocols and to assess preliminary evidence of the effect of the technology facilitated intervention. The proposed study includes 3 phases. Phase I includes in-depth interviews with 30 HIV-negative Thai YMSM to explore barriers and facilitators of PrEP initiation and adherence to inform intervention content. Phase II consists of adapting and beta testing MES-PrEP and MTM for functionality and feasibility using 10 HIV-negative Thai YMSM. In Phase III, we will conduct a pilot randomized controlled trial to evaluate the feasibility, acceptability, and preliminary efficacy of MAS-PrEP and MTM to increase PrEP uptake and adherence among Thai YMSM. We will enroll 60 HIV-negative Thai YMSM who have not started PrEP and 60 YMSM who are on PrEP but not adherent to it. Participants will be randomized 2:1 to received MES-PrEP and MTM (n=40) or Standard PrEP Counseling (n=20). Feasibility and acceptability of the intervention will be assessed through paradata of usage patterns and the System Usability Scale. Preliminary impact will be assessed by evaluating the proportion of PrEP initiation and level of adherence to PrEP. Participants will complete the assessments at baseline and 1, 3, and 6 months post- intervention. Biomarkers of adherence to PrEP and HIV/STI will be collected. Upon project completion, we shall have developed a highly innovative mHealth intervention to support MSM using PrEP which will be ready for testing in a larger efficacy trial.