P3 (Prepared, Protected, emPowered) (P3)
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.|
|ClinicalTrials.gov Identifier: NCT03320512|
Recruitment Status : Completed
First Posted : October 25, 2017
Last Update Posted : September 28, 2021
|Condition or disease||Intervention/treatment||Phase|
|Sexually Transmitted Diseases Safe Sex Adherence, Medication||Behavioral: P3 Behavioral: P3+ Behavioral: Control||Not Applicable|
Sustainable, integrated PrEP adherence interventions are critically needed to reduce HIV incidence among YMSM and YTW. It is imperative that the investigators develop adherence interventions for YMSM and YTW initiating PrEP that are engaging, age-appropriate and take advantage of technologies that are already embedded in these individual's lives. A smartphone-delivered PrEP adherence intervention is well suited for this population, given they have a high-uptake and utilization of smartphone technology. The use of smartphones to deliver HIV prevention and care interventions has grown substantially in recent years due to: a) wide-scale adoption of smartphone technology among high-risk groups, b) the ability to deliver interventions in real-time within risk contexts, and c) low implementation costs.The accessibility, affordability, anonymity and acceptability of smartphones make them the intervention medium of choice for engaging youth and a logical platform to deliver an adherence intervention targeting PrEP. Further, smartphone interventions address can overcome issues that impede engagement with in-person interventions such as transportation logistics, stigma and confidentiality. Further youth, including YMSM and YTW are receptive to smartphone delivered interventions and these interventions can impact HIV related prevention behaviors.
P3 (Prepared, Protected, emPowered) is an interactive smartphone app for HIV-uninfected YMSM and YTW that utilizes social networking and game-based mechanics as well as a comprehensive understanding of what constitutes "best practices" in app development to improve PrEP adherence and persistence in PrEP care. Built on a successful, evidence-based platform designed and tested by our collaborating technology partner, Ayogo, P3 is flexible and responsive to changes in technology. This flexibility will also allow us to quickly respond to and modify our intervention to align with emerging PrEP practice standards and guidelines.
Despite the benefits of app-based interventions, maintaining engagement over time can be particularly challenging. Lack of rapport building may contribute to lower retention rates in technology-based interventions. Further, the available literature suggests that some tools, including technology based tools, may be more beneficial to patient adherence when combined with education or counseling. To investigate this possibility, the investigators will include a study arm (P3+) that includes P3 and adherence counseling delivered by a counselor through the P3 app.
This study has three phases, usability testing, field testing, and a randomized-controlled trial (RCT). In usability testing the investigators will test beta versions of the app and gain feedback about the intervention from the target population, identify any technical issues, and get feedback on app content. Field testing is to ensure that the features, platform and content of P3 and P3+ are acceptable to the target population and that there are no technical challenges or user concerns with either the app, the dried blood spot (DBS), hair, or mitra sampling collection.
The last phase is a three arm, RCT that will test the efficacy of P3, a novel, theory-based mobile app that utilizes game mechanics and social networking features to improve PrEP adherence, retention in PrEP clinical care, and PrEP persistence among young men who have sex with men (YMSM) and young trans women (YTW) who have sex with men, ages 16-24. The investigators will test the efficacy of P3 and P3+, which adds Next Step Counseling delivered by an adherence counselor through the app, against PrEP standard of care. Participants will be randomized to P3, P3+, or standard of care. A cost comparison between P3 and P3+ will be conducted.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||246 participants|
|Intervention Model:||Factorial Assignment|
|Intervention Model Description:||The trial will consist of a three-arm RCT to test intervention efficacy among young men who have sex with men (YMSM) and young transgender women who have sex with men (YTWSM) who are starting PrEP or are non-adherent to PrEP. Study arms will include P3, P3+, and standard of care (SOC). Participants will be recruited from seven cities. The investigators will enroll up to 240 participants and randomize them 2:2:1 to receive P3, P3+, or SOC. Assessments will be completed at months 0, 3, and 6.|
|Masking:||None (Open Label)|
|Official Title:||P3 (Prepared, Protected, emPowered): Promoting Pre-exposure Prophylaxis (PrEP) Adherence Through a Social Networking, Gamification, and Adherence Support App|
|Actual Study Start Date :||May 15, 2019|
|Actual Primary Completion Date :||September 16, 2021|
|Actual Study Completion Date :||September 16, 2021|
Participants will use P3
P3 is an interactive smartphone app that utilizes social networking and game-based mechanics to improve PrEP adherence and persistence in PrEP care. The participant will install P3 on their phone, receive a guided tour of the app and a reminder card with the research coordinator's phone number and email address and instructed to contact the research coordinator immediately to report difficulties with any app components or to report any problems with their phone or phone service. A help link is embedded within the app that directly links to study staff if assistance is needed. P3 arm participants will have 24-hour access to all features of P3.
Other Name: Prepared, Protected, emPowered
Participants will use P3+
In P3+, participants receive all of P3 and the ability to text in the app with an adherence counselor, using Next Step Counseling (NSC). NSC is an interactive, client-centered motivational intervention to improve PrEP adherence. Key components of NSC include: review experiences with adherence, exploration of adherence facilitators and barriers, identification of adherence needs, identification of strategies to meet needs, and development of an adherence action plan. Participants will install P3+ on their phone. The adherence counselor feature will be unlocked for those in the P3+ arm. P3+ participants will have 24-hour access to all features of P3+.
Placebo Comparator: Control
Participants will receive the standard of care
Control participants will receive the standard of care for receiving a prescription for PrEP.
- Changes in PrEP adherence from Baseline to Month 6 [ Time Frame: Baseline, Month 3, Month 6 ]PrEP adherence is measured by blood sample levels of tenofovir diphosphate and emtricitabine triphosphate (TFV-DP/FTC-TP) with blood concentration consistent with > 4 doses/week at 3- and 6- month follow-ups
- Long-term adherence durability [ Time Frame: Month 6 ]Protective levels of TFV-DP/FTC-TP at month 6.
- Self-reported retention in PrEP clinical care [ Time Frame: Month 6 ]The investigators define "retention in care" as PrEP clinical visits every 3 months.
- PrEP persistence [ Time Frame: Month 6 ]PrEP persistence will be measured by the average duration of PrEP use before an individual temporarily or permanently discontinues PrEP. This will be collected via self-report at follow up.
- Sexual Risk Behaviors [ Time Frame: Month 6 ]Sexual Practices Assessment Schedule will be used to measure changes in sexual behavior by gender (man, transgender woman, non-binary), three different types of partners (romantic interest, casual partner "hookup" or friend with benefits), use of condoms during the past 3 months, and knowledge about partners' HIV status or PrEP use.
- Changes in Sexually Transmitted Infections (STI) Incidence [ Time Frame: Baseline, Month 3, Month 6 ]Self-reported STIs (rectal and urethral gonorrhea and chlamydia, syphilis) in last 3 months.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03320512
|United States, Florida|
|University of South Florida Infectious Diseases|
|Tampa, Florida, United States, 33606|
|United States, Georgia|
|Atlanta, Georgia, United States, 30322|
|United States, Illinois|
|The Adolescent and Young Adult Research (AYAR) at the CORE Center|
|Chicago, Illinois, United States, 60612|
|United States, Massachusetts|
|The Fenway Institute|
|Boston, Massachusetts, United States, 02215|
|United States, New York|
|Children's Hospital at Montefiore|
|Bronx, New York, United States, 10467|
|United States, North Carolina|
|Chapel Hill, North Carolina, United States, 27599|
|Charlotte, North Carolina, United States, 29202|
|United States, Pennsylvania|
|Adolescent Initiative at Children's Hospital of Philadelphia|
|Philadelphia, Pennsylvania, United States, 19104|
|United States, Texas|
|Texas Children's Hospital|
|Houston, Texas, United States, 77030|
|Principal Investigator:||Lisa Hightow-Weidman, MD||UNC Chapel Hill|