An Acceptance Based PrEP Intervention to Engage Young Black MSM in the South

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PROJECT SUMMARY/ABSTRACT Young Black men who have sex with men (YBMSM) have a high incidence of HIV, particularly in the South. Thus, interventions tailored to YBMSM to enhance engagement in prevention services are urgently needed. Engagement in PrEP care among YBMSM is less then optimal. The modified social ecological model (MSEM) defines the multi-level domains of HIV infection risk among key populations. Barriers to PrEP use among YBMSM occur at each level: 1) individual, 2) social and sexual network, 3) community, 4) policy, and 5) stage of the HIV epidemic. Examples include individual (e.g. perception of HIV risk), social and sexual network (e.g. stigma), community (e.g. lack of medical services), and public policy (e.g. cost of care). The boundary between each level is permeable, thus each is considered in the proposed study. Utilizing components of Acceptance and Commitment Therapy (ACT), we will design an intervention to improve PrEP uptake, persistence, and adherence. We will use a generalized framework for the adaptation of EBIs to inform the development of a brief intervention for PrEP tailored to YBMSM, named ACTPrEP. ACT addresses barriers by promoting: 1) present moment awareness, 2) acceptance of internal and external experiences, and 3) engagement in behaviors that are consistent with values. To maximize utility, ACTPrEP will be delivered by a PrEP navigator. Candidate: Dr. Arnold is a medical clinical psychologist/scientist with a research background in HIV related studies in the South. Her career has focused on HIV intervention and prevention. Building on prior research, she is applying for a five-year K23 Career Development Award. Mentoring: An exceptional team of senior investigators serve as mentors. Dr. Brown is the Primary Mentor and has expertise in the designing and implementing of PrEP Interventions. Four co-mentors bring complementary expertise in PrEP delivery for YBMSM in the South and adherence monitoring (Dr. Mena); adapting behavior change interventions (Dr. Gaudiano); implementation science (Dr. Elwy); and quantitative data analyses (Dr. Jones). Research: The proposed aims are 1) Gather data from YBMSM (n = 20) and clinic staff (n = 10) through in- depth interviews to assess measures, intervention design, and barriers; 2) Develop ACTPrEP utilizing Aim 1 data and working iteratively with experts; and 3) Evaluate ACTPrEP feasibility and acceptability through a randomized control trial (n=66) and compare ACTPrEP vs. enhanced standard of care on uptake, adherence, and PrEP persistence. Trainings: Dr. Arnold will receive specific training in designing, adapting, and testing theory-based interventions, addressing health disparities with racial and sexual minorities, implementation science, and quantitative analyses through coursework, seminars, workshops, directed readings, and mentored research. These training and research experiences will establish the candidate’s career as an expert in clinically informed behavior change interventions. The candidate is supported by Rhode Island Hospital.