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Acceptability and Feasibility of a Mobile Phone Application to Support HIV Pre-exposure Prophylaxis Among Women with Opioid Use Disorder

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Abstract

Despite evidence supporting HIV pre-exposure prophylaxis (PrEP) effectiveness, very few women with opioid use disorder (OUD) take PrEP. Interventions that improve medication assisted treatment (MAT) uptake and adherence may also be beneficial for PrEP. The reSET-O mobile phone app is a component of the evidence-based Therapeutic Education System, which improves retention and abstinence for people with OUD. To better understand use of this mobile health tool as a support for PrEP among women with OUD, pre-implementation contextual inquiry is needed. Therefore, we set out to assess target user characteristics, implementation barriers, feasibility, and acceptability of reSET-O. We recruited women with OUD receiving care from a community-based organization in Philadelphia to complete semi-structured interviews. All participants were prescribed reSET-O. We interviewed 20 participants (average age 37 years; 70% white, 15% Hispanic, 5% Black) from 5/2021 to 2/2022. We used an integrated analysis approach combining modified grounded theory and implementation science constructs. Half reported recent injection drug use, and 6 were taking buprenorphine. Mental health symptoms were common, and half described engaging in transactional sex. The majority expressed strong interest in PrEP. Participants reported the app would be highly acceptable for PrEP and MAT adherence support, but only two redeemed the prescription. The most common barriers included phone and internet access. Our findings highlight potential implementation challenges for the use of such an app to support PrEP use in this population. Poor uptake of the app at follow-up indicates that initial prescription redemption is a major barrier to reSET-O implementation.

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Data Availability

The interview guide is included in our submission. Data are available upon reasonable request to the senior author.

Abbreviations

App:

Application

CBT:

Cognitive behavioral therapy

HIV:

Human immunodeficiency virus

MAT:

Medication assisted therapy

OUD:

Opioid use disorder

PrEP:

Pre-exposure prophylaxis

PWID:

People who inject drugs

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Acknowledgements

The authors acknowledge the participants for generously giving their time for the study.

Funding

This study was funded by the Penn Center for AIDS Research (CFAR) (Award #10069025). Contingency management within the reSET-O app was funded by Pear Therapeutics.

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Aaron Richterman, Fatemeh Ghadimi & Florence Momplaisir

  2. School of Nursing, University of Pennsylvania, Philadelphia, PA, USA

    Anne M. Teitelman

  3. Courage Medicine, Philadelphia, PA, USA

    Kevin Moore, Trisha Acri, Hannah North, Kasandra Lopez & Vuthy Ou

  4. Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA

    Amelia E. Van Pelt

  5. Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA

    Amelia E. Van Pelt & Florence Momplaisir

  6. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA

    Amelia E. Van Pelt

  7. Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Aaron Richterman

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  1. Aaron Richterman
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Contributions

FM, KM, and TA conceived of the study. KM, TA, HN, KL, and VO conducted data collection. AR and FG conducted primary data analysis with input from AMT, AEV, and FM. AR wrote the first draft of the manuscript, with critical input from all authors.

Corresponding author

Correspondence to Aaron Richterman.

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Competing Interests

The authors declare no conflicts of interest.

Ethical Approval

The study was approved by the Institutional Review Board of the University of Pennsylvania.

Consent to Participate

Written informed consent was obtained from all participants. No participants withdrew from the study.

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Richterman, A., Ghadimi, F., Teitelman, A.M. et al. Acceptability and Feasibility of a Mobile Phone Application to Support HIV Pre-exposure Prophylaxis Among Women with Opioid Use Disorder. AIDS Behav 27, 3460–3467 (2023). https://doi.org/10.1007/s10461-023-04060-w

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