Development of a Community-based HIV Pre-Exposure Prophylaxis Service Delivery Intervention for Black Adults in the District of Columbia

September 21, 2022
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Donaldson Conserve, MS, PhD (GW) has received an NIH CFAR Administrative Supplement entitled, “Development of a Community-based HIV Pre-Exposure Prophylaxis Service Delivery Intervention for Black Adults in the District of Columbia”.

The Centers for Disease Control and Prevention estimates that 1 in 13 residents in Washington, DC will acquire HIV in their lifetime, and 255 new HIV cases were diagnosed in 2019 (1). Of those newly HIV diagnosed (2015-19), 1 in 4 were Black women and 2 in 5 were Black men who have sex with men (MSM), and Black heterosexual men and women were 3.3 and 34.7 times more likely to be living with a HIV than their White counterpart. Given the high HIV burden in DC, Black residents and low-income neighborhoods are particularly poised to benefit from non-traditional pre-exposure prophylaxis (PrEP) service delivery models that overcome structural barriers. Community-based (e.g., via mobile health units or vans, tents, or other mobile structures) PrEP initiation and service delivery model has the potential to increase PrEP uptake, particularly among highly marginalized residents and in underserved communities. To date, community-based PrEP (cbPrEP) approaches have not been fully investigated. Our multi-disciplinary team has empirical implementation science data demonstrating community-based ART (cbART) initiation and retention (e.g., at home or via community-based canvas tents) in low resource global settings such as Tanzania (8). Using the Assessment, Decision, Adaptation, Production, Topical Experts - Integration, Training, Testing (ADAPT-ITT) framework (24), we propose a two-phase study to: 1) Develop/Adapt a cbPrEP intervention for Black adults in DC based on a successful community-based HIV treatment and prevention intervention mode and;  2)  Assess the acceptability, feasibility, appropriateness of the cbPrEP service delivery model. Phase I will consist of qualitative focus groups/interviews with DC Department of Health (DOH) stakeholders, PrEP providers, CBO stakeholders, and potential and existing PrEP users to guide the intervention adaptation process. Focus group guides/domains include willingness to uptake different PrEP modalities, type of service delivery model (e.g., CBO facility-based or mobile/tent site-based), and cbPrEP team composition. Findings will inform the prototype intervention model and feedback from technical experts for further refinement. In Phase II, we will pilot the cbPrEP intervention among 60 Black adult participants. Participants will complete a survey at baseline and at 45 days post-enrollment, and a subset will participate in FGDs. In-depth interviews will also be conducted with those who are deemed eligible for PrEP but do not enroll in cbPrEP and providers implementing the cbPrEP intervention (N=10). Our unique team (academic, international NGO, CBO, DC DOH) proposes to adapt our cbART service delivery model in international settings for PrEP among Black adults in DC. Alternative strategies to PrEP service delivery are needed to increase uptake of PrEP among those most in need, which can have a significant impact on the Ending the HIV Epidemic efforts. If cbPrEP delivery is found to be acceptable, feasible, and appropriate, we will develop an R01 to test the intervention’s efficacy on PrEP uptake and continuation among Black adults in DC.