Yale University

Implementation of HIV Pre-Exposure Prophylaxis for Men who have Sex with Men with and without Substance Use in Providence and New Haven

Funder: National Institute of Mental Health
Project period: 04/24/2015 - 04/30/2016
Grant Type: Pilot Project

Abstract Text:

Emtricitabine/tenofovir (Truvada), a once daily medication, was approved by the Food and Drug Administration in 2012 for pre-exposure prophylaxis (PrEP) to prevent HIV infections, yet is uptake has been limited.  In addition to limited knowledge of PrEP among patients and their providers, there is concern about the effectiveness of PrEP when taken by high-risk individuals in routine clinical settings with regard to risk behaviors (i.e. risk compensation) and how it will be taken (i.e. medication adherence). Efforts to promote knowledge of PrEP among MSM with and without substance use (a group disproportionately impacted by HIV), and evaluate clinical implementation of this evidence-based intervention for HIV prevention are needed.  Grounded in the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework, the goals of this study are to: (1) compare the yield of an ouline outreach intervention to in-person strategies for increasing reach of PrEP to MSM with and without substance use in Providence, Rhode Island, and New Haven, Connecticut; and (2) examine the impact of substance use among MSM on the effectiveness (i.e. uptake), implementation (i.e. adherence), and maintenance (i.e. retention in care at 3 months) of PrEP.  The outreach intervention will include dissemination of educational materials and PrEP resources to increase knowledge and update of PrEP among MSM attending online and in-person venues, including sex clubs, bathhouses, HIV clinics, sexually transmitted disease (STD) clinics, lesbian/gay/bisexual transgender centers, and other community-based organizations, and their providers.  Men will be referred to PrEP clinics in Providence or New Haven for evaluation, and those initiating treatment will be recruited to enroll in a short-term cohort.  Conducted by a multi-disciplinary team, this innovative implementation project will inform future interventions and a larger NIH grant submission for reaching MSM, especially those with substance use, for PrEP in small urban centers to optimize HIV prevention.