PROMOTING PRE-EXPOSURE PROPHYLAXIS (PrEP) REGIMEN ADHERENCE THROUGH A MULTIFACETED APPROACH TO INCREASE ADHERENCE: A QUALITY IMPROVEMENT PROJECT

Purpose The purpose of this scholarly project was to implement the use of daily text message reminders to promote PrEP medication regimen adherence, thereby reducing the risk of HIV acquisition in an at-risk population. Patient interviews and surveys were also conducted to obtain valuable information regarding barriers and facilitators to PrEP regimen adherence. Background The project was implemented at a homeless shelter in Harris County, Houston, Texas, that houses homeless youth ages 18-24 while also providing medical, educational, and financial services or assistance. Due to risky behaviors prevalent in this population, coupled with living in the Houston area, these patients are at an increased risk for HIV acquisition. Methodology Daily text message reminders were sent to patients who consented to text message communication. The use of text messaging allowed for two-way communication between patients and staff to address any issues or concerns regarding the medication. The medication adherence rate was calculated weekly for all prescribed patients. Changes to the intervention were employed according to the Plan-Do-Study-Act quality improvement method. Results Four out of nine patients prescribed PrEP participated in receiving text message reminders and patient interviews. After five months of medication administration tracking, daily text reminders, patient interviews, and interactions, results revealed that all patients who received text message reminders maintained a 100% adherence rate to their prescribed PrEP medication regimen. Adherence rates for those who did not participate in text message reminders varied from 100% adherence to 0% adherence, with an average of 51.2% adherence. Meetings with patients revealed that motivators for adhering to treatment were based on fears of HIV acquisition and ease of attaining the medication. Implications The use of text message communication in healthcare settings offers benefits such as enhanced communication, increased patient engagement, and improved patient adherence. Additionally, these results highlight the benefits of text message reminders in reducing missed medication doses and promoting medication adherence. Patient interviews are beneficial because they facilitate a deeper understanding of the patient and factors that impact their health and well-being so that care can be tailored to meet the patient's needs, ultimately leading to better patient outcomes.