Developing and testing a telehealth intervention to increase HIV pre-exposure prophylaxis uptake and adherence among sexual minority men in Nigeria

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PROJECT SUMMARY Background. In Nigeria, sexual minority men (SMM) have disproportionately higher levels of HIV compared to the general population. With high adherence, daily oral pre-exposure prophylaxis (PrEP) reduces risk for HIV acquisition among SMM. Increasing PrEP uptake and adherence could significantly reduce HIV incidence, but to date no PrEP intervention have focused on SMM in Nigeria. The scientific premise of this K01 application is that a telehealth delivery model for PrEP could circumvent barriers to PrEP access for SMM in Nigeria. There is a strong proof of concept for the proposed approach given that telehealth interventions to enhance PrEP access have been shown to be acceptable and have increased PrEP uptake and adherence, among SMM in the U.S. While telehealth interventions in Nigeria have increased utilization of other health services, no study has investigated the feasibility, acceptability, and efficacy of delivering PrEP health services to SMM in Nigeria through a telehealth approach. Overview of project. My long-term goal is to become an independent researcher with expertise in developing and testing telehealth interventions to improve HIV prevention and care outcomes among SMM in sub-Saharan Africa. In Year 1, I will conduct qualitative interviews with HIV-negative SMM (n=20), peer educators (n=20), and healthcare providers (n=20) in Lagos Nigeria to identify the content, format, and foreseeable challenges to implementing a telemedicine intervention to increase PrEP awareness, uptake, and adherence among SMM. In Year 2, I will conduct qualitative interviews with SMM (n=30) to iteratively design a telemedicine intervention to increase PrEP uptake and adherence among SMM in Lagos, Nigeria. In Years 3-5, I will conduct a pilot randomized controlled trial (RCT) to test the feasibility, acceptability, and preliminary efficacy of the telemedicine intervention to optimize PrEP adherence over 6 months with 90 PrEP-naïve, HIV-negative high risk SMM in Lagos, Nigeria. My successful completion of the proposed research and training aims will position me to submit a R01 in the final year of this grant to conduct a multisite, RCT to test the intervention’s efficacy.