Integrating Mobile Text Messaging Pre-Exposure Prophylaxis Navigation Services Into a Home HIV and Sexually Transmitted Infection Self-Testing Program in the United States: Formative Work and Pilot Implementation Study.

Background: HIV testing is the gateway to the HIV prevention continuum and offers an important opportunity to provide HIV prevention services. TakeMeHome.org is an online program that enables state and local health departments to offer free in-home HIV and sexually transmitted infection self-testing. As few TakeMeHome users have used pre-exposure prophylaxis (PrEP), there is an opportunity to link TakeMeHome users to PrEP information and services. Objective: The aim of this study is to develop an implementation strategy to link HIV or sexually transmitted infection self-testers from online orders to PrEP services via direct digital linkage to a novel SMS text messaging navigation program. Methods: PrEPmate is an evidence-based bidirectional text-messaging platform that has demonstrated increased PrEP retention and adherence. We developed a novel program to link TakeMeHome testers to mobile SMS text messaging PrEP navigation via PrEPmate. We conducted focus groups among TakeMeHome users to elicit preferences for linkage from TakeMeHome to PrEPmate. Based on these focus groups, we revised the content and functionality of this linkage intervention. In October 2023, we launched a pilot implementation study in 2 US Ending the HIV Epidemic jurisdictions: Sacramento, California, and Tarrant, Texas. Results: Thirteen TakeMeHome users participated in 4 focus groups (mean age 31.5 years; n=4, 31% Latinx, n=2, 15% Black; n=9, 69% never used PrEP). When shown wireframes of the TakeMeHome or PrEPmate linkage, most thought they were easy to navigate and user-friendly. They liked the privacy of connecting with a PrEP navigator using SMS text messaging. Participants recommended providing a clear description of PrEP and PrEPmate services and indicating that PrEP is low or no cost on the TakeMeHome website. On the PrEPmate landing page, they recommended adding language on confidentiality and the partnership with TakeMeHome to show that both services are connected. Once enrolled, they recommended weekly or biweekly check-ins to assist with PrEP navigation. Overall, 92% (12/13) of focus group participants were likely to use PrEPmate to learn more about PrEP and/or link to PrEP services. From October 2023 to May 2024, among 537 individuals who ordered test kits and were not on PrEP, 169 (31%) were linked to the PrEPmate page, and 86 (16%) enrolled in PrEPmate. PrEP navigation was provided via SMS text messaging or phone, with 46 (53%) receiving PrEP education and 26 (30%) in various stages of starting PrEP. In exit interviews, participants found the intervention easy to use and appreciated being connected with an experienced PrEP navigator who helped them access PrEP. Conclusions: Through user-centered design, we successfully developed a program to link TakeMeHome testers to PrEP navigation via PrEPmate, with high feasibility and acceptability of the intervention and a substantial number of clients starting PrEP. The next steps will involve evaluating the effectiveness of this program on a larger scale and, if successful, expanding PrEPmate navigation to all Ending the HIV Epidemic jurisdictions using TakeMeHome.