Abstract
To the Editor:
We appreciate this thoughtful commentary on our research regarding the acceptability and feasibility of a home-based HIV pre-exposure prophylaxis (PrEP) program. 1 We value the insights on and attention to our work, which highlight critical areas for further investigation.
Valid points were raised about the sample size and its implications for generalizability. This is a pilot study that adds to the literature regarding barriers and facilitators of home-based PrEP testing, and we acknowledge that a larger, more diverse sample could provide a clearer picture of the barriers to enrollment and engagement. Understanding the gap between expressed interest and actual participation is indeed crucial. It is possible that social desirability bias affected the initial responses of interest, or that upon learning further details of the program, patients decided not to pursue the program further for various reasons for which we do not have complete data. We intend to explore the specific impediments preventing individuals from transitioning to active involvement in such programs in future studies.
We also recognize the limitations of this feasibility study and consider this work as both a contribution to the research question and also an opportunity to identify additional areas for further investigation. Several small studies have found telehealth PrEP programs to be feasible in their small cohorts. 2,3 In our study, identifying factors such as the number of delivery delays to get testing kits to patients, as well as staff turnover, acknowledges the day-to-day practical barriers to broader implementation of home-based PrEP programs. A recent feasibility study of a telehealth PrEP program involving telemedicine appointments and labs collected at local commercial laboratories noted additional barriers, such as delays in appointment scheduling, difficulty reaching patients, and missed laboratory testing. 4 We recognize that understanding how these issues affect patient adherence and satisfaction is essential for improving program outcomes and agree that qualitative methodologies could uncover deeper insights into patient and provider experiences, shedding light on the nuanced challenges faced in implementing home-based PrEP.
Finally, we also agree there is a timely need for a broader conversation on the appeal of telemedicine and home testing. Exploring how cultural, socioeconomic, and demographic factors influence program adoption can enhance our understanding and lead to more tailored interventions. Once again, we appreciate the interest and valuable insights offered in this Letter to the Editor.