Framed Messages to Increase Condom Use Frequency Among Individuals Taking Daily Antiretroviral Medication for Pre-exposure Prophylaxis

PrEP delivery and routine care provide a unique opportunity to promote sexually transmitted infection (STI) prevention by both increasing STI testing frequency and creating a space for affirmative and effective safer sex counseling. This study was a feasibility and acceptability pilot of an adapted framed message intervention to increase condom use frequency with PrEP. In the formative phase, two focus groups with PrEP users (N = 7) provided feedback on a provisional loss-framed message intervention and identified potential study barriers. In the pilot trial, the adapted loss-framed message intervention was compared to a gain-framed message intervention and enhanced skills condition in a sample of PrEP users (N = 29). In terms of intervention feasibility, 58% of approached PrEP users completed the eligibility screen; 79% of those eligible enrolled in the study and 66% of enrolled participants completed the three-month follow-up. In terms of intervention acceptability, participants found the informational messages, regardless of assignment, to be moderately interesting (M = 6.24, SD = 2.97) and useful (M = 7.07, SD = 3.00), and very easy to understand (M = 9.50, SD = 0.97) on Likert-type scales ranging from 1 to 10. In terms of intervention effects, there was a small effect of the gain-framed intervention (b =.58, SE =.93, CI = -1.33, 2.48, Cohen’s d =.26) on HIV/STI risk transmission. There was a small-medium effect of both the loss- (b = 2.00, SE =.90, CI =.15, 3.85, Cohen’s d = 1.46) and gain-framed (b = 2.24, SE =.93, CI =.34, 4.15, Cohen’s d = 1.65) interventions on condom use motivation. Finally, there was a medium-large effect of both the loss- (b =.97, SE = 1.33, CI = -1.88, 3.82, Cohen’s d =.54) and gain-framed intervention (b = 1.97, SE = 1.33, CI = -.88, 4.82, Cohen’s d =.87) on condom use frequency. Further refinement and testing, in a larger -scale trial with higher ecological validity than this initial pilot intervention, is warranted.