Gay, bisexual and other men who have sex with men (GBM) account for over half of new HIV infections in Canada each year, and have a 131-fold higher risk of HIV than other Canadian men. HIV pre-exposure prophylaxis (PrEP) using regular oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) or tenofovir alafenamide/emtricitabine (TAF/FTC) is an effective and safe HIV prevention option. Despite growing interest, awareness and willingness to use PrEP there has been numerous challenges to the broader rollout of PrEP. This study will address some of these challenges by assessing participant satisfaction,feasibility and clinical outcomes associated with a web-based mobile health (mHealth) model of care for daily oral TAF/FTC PrEP compared to standard of care delivery of TAF/FTC PrEP in Canadian GBM/TGW, in the era of COVID-19. The ultimate goal of this study is to provide a scalable model for remote PrEP delivery that minimizes the need for in-person interactions; respects guideline recommendations regarding how to optimally monitor patients; and is attractive to both patients and providers. This study is a 1:1 open-label, pragmatic randomized controlled trial using a AB:BA crossover design, comparing the standard of care to an mHealth based model of care (Freddie® ) for TAF/FTC PrEP delivery over 72 weeks.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
2
Participants will receive Descovy® 200/25mg 1 tablet once daily for 72 weeks.
Freddie® allows for asynchronous contact between patients and care providers, meaning that it does not require both groups to be connected in real time, instead allowing communication over a number of days.
Delivery of PrEP care through the local standard of care
Sexually Transmitted Infection (STI) Clinic
Calgary, Alberta, Canada
Nine Circles
Winnipeg, Manitoba, Canada
Hamilton PrEP Clinic
Hamilton, Ontario, Canada
St. Michael's Hospital
Toronto, Ontario, Canada
Maple Leaf Research
Toronto, Ontario, Canada
'Final Visit Questionnaire' will be used to determine participants' stated preference for either the standard of care or the mHealth-based model of care.
The primary outcome will be defined using the response to the following question: "During this study, your PrEP care was provided through the Freddie platform for part of the study period, and through your clinic's standard procedures for part of the study period. Which of these did you prefer?"
Time frame: 72 weeks
Study visit attendance will be used to compare the number of missed visits by model of care
Measured by study visit attendance (defined as: occasions on which the patient and provider fail to connect for a quarterly follow-up in the pre-planned fashion)
Time frame: 72 weeks
Quantity of missing laboratory questionnaires will be used to compare the number of missed laboratory evaluations by model of care.
Missed laboratory evaluations (secondary outcome B) will be defined as any occasion on which a participant fails to complete their clinically indicated laboratory tests (HIV serology, STI screening, creatinine) by the end of the 9th week of each 12-weekly follow-up cycle.
Time frame: 72 weeks
Interview administered questionnaires will be used to comparison of the average amount of participant time required for PrEP follow-up activities by model of care
Measure of time required for PrEP follow-up activities per quarter will be calculated as the sum (in minutes) of all time spent by the participant on activities related to receiving PrEP care per 12-week follow-up interval, as reported by the participant during study interviews.
Time frame: 72 weeks
Questionnaires administered to clinicians will be used to compare of the average amount of clinician time required for PrEP follow-up by activities per model of care
Measured by total number of minutes spent by the clinician on activities related to delivering PrEP care per 12-week follow-up interval.
Time frame: 72 weeks
Study visit attendance will be followed to compare of the total number of participant visits by model of care
measured from study visit attendance
Time frame: 72 weeks
PrEP adherence questionnaire administered at week 36 and 72 will be used to determine PrEP adherence.
PrEP adherence refers to the degree to which participants take their daily TAF/FTC as prescribed. PrEP adherence questionnaire will include questions of the number of days per week on which PrEP was taken.
Time frame: 72 weeks
Dried blood spot will be collected at week 36 and 72 will be used to determine PrEP adherence.
PrEP adherence refers to the degree to which participants take their daily TAF/FTC as prescribed. Samples will be analyzed for drug levels as this outcome is mapped onto pharmacokinetic outcomes.
Time frame: 72 weeks
Hair Samples will be collected at week 36 and 72 will be used to determine PrEP adherence.
PrEP adherence refers to the degree to which participants take their daily TAF/FTC as prescribed. Samples will be analyzed for drug levels as this outcome is mapped onto pharmacokinetic outcomes.
Time frame: 72 weeks
Participant visit logs will be used to assess retention in PrEP care by model of care.
Measurement of patients' continued engagement in PrEP care, regardless of whether continuing to take PrEP medication.
Time frame: 72 weeks
Interview administered questionnaires will be used to qualitatively learn about the preferences of patients and providers about the mHealth model of care.
Questions assessing pros and cons of each model of care will allow for participants to provide insight about preferences in PrEP care models.
Time frame: 72 weeks
Satisfaction questionnaires will be used to compare participant satisfaction with their PrEP care by model of care.
Measured by questionnaire responses at weeks 4, 12, 36, 48, 60 and at final study visit.
Time frame: 72 weeks
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