The ATEAM Study: Advances in Technology to Enhance PrEP Adherence Monitoring (ATEAM) Among Young Men Who Have Sex with Men (YMSM).

Young age has consistently correlated with lower adherence to PrEP in MSM. Digital medicine, a dynamic healthcare platform of wearable physiological sensors and mobile communication technology that can respond to medication non-adherence rapidly, has the potential in promoting PrEP adherence. We evaluated the feasibility and acceptability of Proteus Discover (PD), a digital monitoring adherence system, to measure PrEP adherence and provide real-time feedback among cisgender YMSM and transgender women.100 HIV-negative young men and transgender women ages 16-24 years were enrolled in a 24-week randomized controlled cross-over study to TDF/FTC coencapsulated with PD vs. TDF/FTC standard-of-care. Participants in the 12-week PD arm received weekly SMS text messages to promote pill taking based on PD adherence data. Dried blood spots (DBS) were collected at 4-week intervals for tenofovir diphosphate (TFV-DP) in red blood cells as the referent and questionnaires were completed to assess acceptability, usability, and patterns of use. Linear mixed models analyzed the relationship between 30-day adherence measured by DBS and PD. PrEP adherence was high overall. Adherence, as measured by DBS, was correlated with adherence as measured by PD (p-value = 0.03). Most participants reported that PD helped them take their PrEP daily and that the system was easy to use. However, a majority (53.5%-60.5%) disagreed with the statement that wearing the patch was not an issue. There was an incremental increase in TFV-DP in DBS with adherence by PD. More research is warranted to explore optimizing PrEP adherence for youth through real-time monitoring.