Table 1.

Summary of findings: interventional U.S. studies using technology to increase PrEP awareness, uptake, adherence, and persistence in care

Primary study modality	First author and publication year	Study focus: patient awareness/acceptability, uptake, adherence, or persistence in PrEP	Study population location/ geographic location of study: urban or rural	Study sample size and race/ethnicities (e.g., Black/African American, Hispanic/Latino) enrolled	Sex/gender identity/sexual orientation—cisgender women, cisgender men, transgender women	HIV transmission risk factor/risky behavior targeted (i.e., MSM, PWID, Heterosexual)	Age group—youth, young adults, only adults, all age groups,	Social and structural barriers discussed or addressed during study	Summary of study/findings
E-Health Platform	Bond et al. (2016) [19]	Patient Awareness/Acceptability of PrEP	Unknown	N = 119 Black/African American = 119 (100%)	Female	Heterosexual	Adults: ≥ 18 years	Stigma; burden of use; long-term use	Study used pre-recorded e-health videos to deliver the intervention. Found 53.9% of women perceived only advantages to using PrEP; 16.4% reported both advantages and disadvantages to using PrEP; 18.7% reported only disadvantages to using PrEP
	Chandler et al. (2020) [20]	Patient Awareness/Acceptability of PrEP	Urban	N = 43 Black/African American = 43 (100%)	Cisgender Women, Bisexual female	Heterosexual	Young Adults: 18–24 years old	PrEP cost; insurance status and type; provider unawareness or unwillingness to prescribe PrEP	Investigators used an e-learning online platform vs. in-person comparison group to deliver the intervention. Among Black women in college, 67% were unaware of PrEP and 72% were apprehensive about initiating PrEP. Results post-intervention found the in-person group had higher scores in learning about PrEP and were likely to use PrEP in the future (72.0%) compared to the online group (62.6%)
Telehealth	Hoth et al. (2019) [23]	Uptake of PrEP, Persistence in PrEP care	Urban Rural	N = 127 White = 103 (81%); Black = 9 (7%); Hispanic/Latinx = 7 (6%); Asian = 2 (3%); Multiracial = 2 (2%); Native American = 1 (1%)	Cisgender Men, Cisgender Women, Gender Fluid/nonbinary	MSM; Heterosexual	Adults: ≥ 18 years	Insurance status and type; PrEP cost	Investigators used live videoconferencing with physicians to prescribe PrEP. Of the 127 participants who completed an initial visit, 91% started PrEP within 7 days. The median number of follow-up days after starting PrEP was 214 days (range 3–609 days). Among participants starting PrEP, retention was 60% at 180 days
	Refugio et al. (2019) [29]	Uptake of PrEP; Adherence of PrEP	Urban	N = 25 Hispanic = 10 (40%); Asian = 8 (32%); White = 4 (16%); Black = 2 (8%); Middle Eastern = 1 (4%)	Cisgender Men	MSM	Young Adults: 18–25 years and older	Access to PrEP home-delivered; transportation; stigma; privacy; health care access to providers; insurance status and type; provider unawares or wiliness to prescribe	Intervention used telehealth visits via telephone to prescribe PrEP. The median time to PrEP initiation was 46 days. Majority of participants (≥ 85%) agreed that PrEPTECH is a better way to receive PrEP at 90 and 180 days. 100% of participants reported that PrEPTECH was very or extremely fast and convenient compared with other forms of getting on PrEP and would continue to use PrEPTECH even if the services were not free
	Stekler et al. (2018) [31]	Uptake of PrEP, Adherence to PrEP	Urban	N = 48 White = 18 (37.5%); Asian = 4 (8.3%); Hispanic = 14 (29.2%); Black = 3 (6.3%); Other/multiracial = 9 (18.7)	Cisgender Men, Transgender Women	MSM	Not specified: 19–46 years old enrolled	Insurance status and type; access to technology; PrEP cost	Intervention used live videoconferencing with a provider to improve PrEP uptake and adherence. Compared with standard-of-care group participants, there were no significant differences in proportions of telehealth participants prescribed PrEP (70% vs. 79%), who attended the first follow-up visit (83% vs. 85%), or adherence at 1-month
mHealth	Fuchs et al. (2018) [21]	Adherence to PrEP	Urban	N = 56 Hispanic = 6 (10.7%); White = 38 (67.9%), Black = 7 (12.5%); Other = 5 (8.9%)	Cisgender men	MSM	Not specified: age summarized as ≤ 30 years old or > 30 years old	No	Intervention used a smartphone mobile app. Mean number of days when medication was not taken was reduced by 50% (95% CI 16–71; p = 0.008), and when comparing missed doses to specific visits before and after iText intervention, the proportion of missed doses was reduced by 77% (95% CI 33–92; p = 0.007)
	Liu et al. (2018) [24]	Adherence to PrEP; Persistence in PrEP	Urban	N = 121 Hispanic/Latino = 43 (36%); Black = 33, (27%;); White = 30 (25%); Asian = 8 (7%); Other = 5 (4%)	Cisgender men, transgender women	MSM	Young adults: 18–29 years old	Access to PrEP	Intervention was delivered with a smartphone mobile app via text messages. Participants who received PrEPmate were more likely to have PrEP levels consistent with ≥ 4 doses/week (72% PrEPmate vs. 57% standard-of-care, SOC) (OR 2.05, 95% CI 1.06–3.94, p = 0.03). For retention, greater percentage of visits were completed by PrEPmate (86%) vs. SOC participants (71%) (OR 2.62; 95% CI 1.24–5.54, p = 0.01)
	Liu et al. (2020) [25]	Adherence to PrEP	Urban	N = 20 Black = 15 (75%) Latino = 5 (25%)	Cisgender Men	MSM	Young Adults: 18–35 years old	Access to PrEP during study and access/navigation to PrEP after study	Use of the directly observed therapy (DOT) app and diary was high, with median PrEP adherence of 91%. Most (84%) participants reported the app helped with PrEP adherence
	Mitchell et al. (2018) [26]	Adherence to PrEP	Unknown	N = 10 White = 7 (70%); Asian = 2 (20%); Multiracial = 1 (10%)	Cisgender Men	MSM	Young adults: 18–30 years old	PrEP cost; family/partner/friend objection; health care access to providers	PrEP adherence increased 30% for participants who used the mobile app. For participants who did not indicate any change, PrEP adherence scores were already at a level considered efficacious (i.e., ≥ 4 doses per week) at baseline. 30% reported a decrease in barriers. Participants self-reported mean PrEP adherence rates of 91% through daily entries in the mSMART app
	Moore et al. (2017) [27]	Adherence to PrEP	Urban	N = 398 Asian = 12 (6.2%); Black = 52 (13.1%); White = 295 (74.1%); Multiple = 24 (6.0%); Other = 7 (1.8%) Hispanic Ethnicity = 119 (29.9%)	Cisgender men, transgender women	MSM	Adults: ≥ 18 years	No	The text messaging intervention did not significantly improve adequate adherence (≥ 719 fmol/punch) compared to the SOC (72.0% vs 69.2%; p = 0.58), but did improve near-perfect adherence (≥ 1246 fmol/ punch) a secondary outcome, through week 48 (33.5% vs 24.8%, p = 0.06) Secondary analysis studies • Blumenthal et al. (2019) [17]—Analysis found the correlation between self-report measures of adherence were significant associated with quantifiable biomarker collected • Blumenthal et al. (2019) [18]—Study calculated modified calculated risk scores to estimate likelihood of HIV seroconversion based on self -reported risk behaviors. Analysis found participants with moderate or high-risk behaviors had higher PrEP adherence levels compared to lower risk groups • Hoenigl et al. (2018) [22]—No statistical difference was found in PrEP adherence among substance users compared to non substance users • Pasipanodya et al. (2018) [28]—growth mixture modeling to identify 4 trajectories of text-reported adherence. Classes with higher reported adherence had higher drug concentrations. Younger age and minority race were associated with lower adherence. Participants reported adherence on 85.10% of days. Greater adherence responses were associated with a higher PrEP concentration (ρ = 0.36; p < 0.001)