Yale University

Pre-exposure Prophylaxis Implementation for HIV Prevention among Substance-using Men who Have Sex with Men

Funder: National Institute of Mental Health
Project period: 11/13/2017 - 11/12/2018
Grant Type: Pilot Project

Abstract Text:

Gay, bisexual and other men who have sex with men (MSM) comprise the group at highest risk of HIV infection in the United States. Use of substances including methamphetamines is associated with significantly increased HIV risk among MSM. Pre-exposure prophylaxis (PrEP) has demonstrated high efficacy in preventing HIV infection among MSM. However, due to numerous structural and individual barriers, PrEP implementation efforts have failed to successfully engage MSM who use methamphetamines. The purpose of the proposed study is to evaluate a network-level intervention to promote update of PrEP and substance use treatment among MSM who use methamphetamines. The study will take place at two existing PrEP clinical programs in New Haven, Connecticut and Providence, Rhode Island. In Specific Aim 1, we will conduct semi-structured individual interviews with MSM who use methamphetamines in Providence and New Haven to characterize social, sexual, and substance use networks among these populations, identify effective methods of recruiting other MSM who use methamphetamines for engagement in PrEP and substance use treatment, and identify barriers and facilitators to substance use treatment and PrEP uptake. In Specific Aim 2, we will conduct an open pilot of a network-level intervention to promote PrEP uptake among MSM who use methamphetamines. The intervention will be developed and pilot tested with ten (10) MSM who use methamphetamines, who will serve as “index” participants for the intervention. Upon receiving PrEP education training, index participants will be given “coupons” to refer members of their networks for services and will be compensated for each member of their network who is successfully referred. Primary outcomes will include the feasibility of this approach, including the number of network members who are methamphetamine-using MSM that are referred and initiate PrEP and substance use treatment. Secondary outcomes will include the number of individuals who are referred for HIV/STD testing. Using a dynamic process of implementation, refinement, and re-implementation, we will assess acceptability and feasibility of specific intervention and evaluation components.