Male Access to Sexual Health Services and PrEP

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PROJECT SUMMARY Global HIV prevention efforts have conventionally focused on supporting women and key populations through treatment as prevention resulting in viral suppression (Undetectable = Untransmittable, U=U). This presents the opportunity to develop interventions that support HIV prevention in heterosexual men, aged 15-49 years. Since there are no interventions that address PrEP uptake among HIV seronegative heterosexual men, the scientific goal of this K43 is to develop and prototype an evidence-based intervention to curb HIV acquisition in South African men at high risk of HIV acquisition. Behavioral economics (BE) theory posits that contextual and individual factors influence health behavior. BE will be used to understand these factors associated with pre- exposure prophylaxis (PrEP) uptake in South African men. Candidate: I am a South African behavioral scientist with a background in HIV research in HIV endemic communities in South Africa I am committed to improve health seeking in this population. This K43 will support my training, mentorship, and research towards becoming an independent investigator. Mentoring: I have assembled a multi-disciplinary team with globally recognized expertise in their fields, committed to HIV research in South Africa. My primary mentors are Dr. Alison Buttenheim (U.S. based, behavioral economics intervention design, evidence-based HIV care delivery, mixed methods research), Dr. Linda-Gail Bekker (S.A.-based, clinical trials, PrEP, research in key populations). My co- mentorship team includes: Dr. Joseph Daniels (U.S.-based, qualitative research, HIV prevention and treatment), Dr. Andrew Medina-Marino (S.A.-based, epidemiology, men’s health, implementation science). Training: The K43 will support mentoring and rigorous training to support me to develop expertise in 1) behavioral economics intervention design, 2) cohort design and managing clinical trials, 3) mixed methods research design and analysis. These aims will be supported by mentors who are global leaders in HIV prevention in limited resource communities. Research: HIV prevalence peaks in South African males (45-49 years) later than their female (35- 39 years) counterparts and males tend to choose younger female sexual partners. Reducing HIV acquisition among men living in LMICs is central to breaking this cycle of transmission. The specific research aims of this award are to: 1) investigate the influence of contextual factors on PrEP uptake, 2) describe factors associated with attrition and sustained PrEP use 3) to use BE to develop and prototype an intervention to support PrEP uptake among men. This research is nested in the existing mobile clinic services operating in the Klipfontein district in Cape Town, which was recently awarded a PrEP implementation grant (Bill and Melinda Gates Foundation, PI Bekker) to assess community-based PrEP uptake. This study will advance NIH science on HIV prevention in men in high HIV disease burden communities. The evidence will be used to design a BE informed intervention for a larger clinical trial investigating the impact on reducing HIV acquisition and transmission in men.