PrEP Initiation and Adherence among Black SMM: A Social Network-Level Intervention

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PROJECT SUMMARY Background. The social networks of Black men, including Black gay, bisexual and other Black sexual minority men (SMM), influence their decision-making and HIV-related behaviors (e.g., condom use, HIV testing). Social networking strategies (SNS) interventions have been successful at increasing HIV testing among Black SMM who had never been tested and with unknown HIV status in Washington, D.C. (McCree et al., 2013; Baytop et al., 2014). A recent differential effectiveness study among Black SMM in Washington, DC (conducted at Us Helping Us) demonstrated SNS to be superior to venue testing and partner services in recruiting men that had never been tested (Baytop et al., 2014). SNS interventions also circumvent structural barriers to pre-exposure prophylaxis (PrEP) such as stigma, discrimination and medical mistrust. The proposed study aims are to design and open-phase pilot a low-intensity, cost-effective SNS intervention to increase PrEP initiation among Black SMM. This is critical because Black SMM have the highest HIV incidence in the U.S. and based on current HIV prevention, treatment and care rates, 50% of Black SMM will acquire HIV in their lifetime compared with ~10% of White SMM and 25% of Latino SMM Importantly, this highlights a critical failure of the U.S. public health system. Therefore, focused HIV prevention and social network-based intervention efforts, such as SNS, are warranted to meet the unique needs of Black SMM. Overview of project. The first 12 months (Phase 1: Formative Research) will be an intervention development/adaptation phase. Using a community-based participatory approach (n=18 age- and PrEP use profile-specific focus groups, of at least 4-5 participants each, totaling 72-90), participants will be asked about the social network dynamics and characteristics (e.g., influential network members, communication about PrEP as an HIV prevention method) that influenced their decision to initiate PrEP. Among participants with no PrEP use, they will be asked about the acceptability and feasibility of talking with PrEP-using Black SMM within their respective social network to support initiation along with preferences for relevant PrEP-related information from peers. The following 12 months (Phase 2: Open-phase Pilot Study) will involve conducting an open pilot of the SNS intervention, in up to six batches of up to 5 participants (n=30), allowing for further intervention refinement. This will allow us to demonstrate participant feasibility and acceptance, which includes the ability to recruit network members, feasibility of intervention delivery, and changes in participant behaviors. It will allow for further evaluation of the feasibility of all study procedures, refinement of intervention manual, and provide pilot data to submit an NIH application for a larger prospective trial. Therefore, the expected outcome is a culturally relevant SNS intervention to increase PrEP initiation among Black SMM through PrEP-using social network members.