Advancing Pre-exposure Prophylaxis (PrEP) Delivery among Black MSM in the District of Columbia

Marc Siegel, MD

October 13, 2015

New HIV infections in the United States are increasingly concentrated among black men who have sex with men (BMSM), particularly among younger BMSM. Although oral pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy for at-risk individuals, PrEP uptake has been relatively low among BMSM.  Younger age, minority race/ethnicity, and sexual minority status are all potential barriers to the receipt of appropriate health care. Thus, there is a critical need to develop innovative strategies for identifying this vulnerable population, engaging them in HIV prevention services (including PrEP), and ensuring that PrEP users remain adherent and linked to clinical care. One strategy is to provide an age- and culturallycompetent,comprehensive resource center that would help link interested BMSM to PrEP services and support ongoing adherence.
The specific aims of this study are: 1) To identify strategies for engaging and retaining younger BMSM (age 16-25) in PrEP services, and 2) To test if access to a resource center tailored to the gender-, race-, and sexual orientation-specific needs of younger BMSM is associated with PrEP uptake and adherence as compared to standard referral. To accomplish Aim 1, we will build on existing formative research and community partnerships to conduct a large (N=250) cross-sectional survey of MSM (age 16-25) in DC using a combination of venue-based and internet sampling. The survey will measure current PrEP knowledge and use, perceived risk for HIV, sexual risk behaviors, health care use, and structural facilitators and barriers. Aim 2 will include a pilot randomized trial (N=50) to evalute the impact of a health center intervention informed by the data collected in Aim 1 as well as the BMSM-specific Client-Centered Care Coordination (C4) strategy currently being assessed in HPTN 073 to motivate PrEP uptake. Outcomes of interest will include reported intention to use PrEP, accessing PrEP services, obtaining PrEP drugs, maintaining >80% adherence, and HIV/STI incidence. Successful completion of this pilot project will provide sufficient preliminary data for submitting an NIH R34 or R01 application to test the BMSM health center model in a large randomized trial.
Black and young men who have sex with men are among the only US populations to have recently experienced a significant increase in the number of incident HIV infections. This project seeks to test whether a novel culturally competent clinic intervention can increase the uptake of pre-exposure prophylaxis (PrEP) to prevent HIV infection in this population.