Acceptance of digital phenotyping linked to a digital pill system to measure PrEP adherence among men who have sex with men with substance use

Abstract

Once-daily oral HIV pre-exposure prophylaxis (PrEP) is an effective strategy to prevent HIV, but is highly dependent on adherence. Men who have sex with men (MSM) who use substances face unique challenges maintaining PrEP adherence. Digital pill systems (DPS) allow for real-time adherence measurement through ingestible sensors. Integration of DPS technology with other digital health tools, such as digital phenotyping, may improve understanding of nonadherence triggers and development of personalized adherence interventions based on ingestion behavior. This study explored the willingness of MSM with substance use to share digital phenotypic data and interact with ancillary systems in the context of DPS-measured PrEP adherence. Adult MSM on PrEP with substance use were recruited through a social networking app. Participants were introduced to DPS technology and completed an assessment to measure willingness to participate in DPS-based PrEP adherence research, contribute digital phenotyping data, and interact with ancillary systems in the context of DPS-based research. Medical mistrust, daily worry about PrEP adherence, and substance use were also assessed. Participants who identified as cisgender male and were willing to participate in DPS-based research (N = 131) were included in this subsample analysis. Most were White (76.3%) and non-Hispanic (77.9%). Participants who reported daily PrEP adherence worry had 3.7 times greater odds (95% CI: 1.03, 13.4) of willingness to share biometric data via a wearable device paired to the DPS. Participants with daily PrEP adherence worry were more likely to be willing to share smartphone data (p = 0.006) and receive text messages surrounding their daily activities (p = 0.003), compared to those with less worry. MSM with substance use disorder, who worried about PrEP adherence, were willing to use DPS technology and share data required for digital phenotyping in the context of PrEP adherence measurement. Efforts to address medical mistrust can increase advantages of this technology for HIV prevention.

Author summary

Oral medications for HIV pre-exposure prophylaxis (PrEP) are highly efficacious in preventing HIV infection, but efficacy is closely linked with adherence. Despite the availability of PrEP, measuring adherence and responding to nonadherence events remains difficult. One possible strategy to measure PrEP adherence is using a digital pill system (DPS) that activates directly in the stomach and reports adherence events. Integrating contextual markers like smartphone digital phenotyping may enhance behavioral interventions that leverage DPS adherence data to provide PrEP adherence support. Here, we conducted a survey study through a social networking website to understand perceptions of the DPS and linked digital phenotyping among MSM with substance use on PrEP. We found that the degree of substance use did not mediate willingness to participate in research using digital phenotyping and the DPS. Individuals who worried more about PrEP adherence were more willilng to interact with the DPS and digital phenotyping techniques.