Acceptability, feasibility, and preliminary impact of a web-based, HIV prevention toolkit with cisgender male couples in Lima, Peru

1摘要/摘要

1 SUMMARY / ABSTRACT 2 3 Sexual minority men in Lima, Peru are disproportionately impacted by HIV, and a substantial proportion of these 4 men acquire HIV while in a relationship (i.e., cisgender male couples). Studies conducted by members of the 5 investigative team found that cisgender male couples’ use of evidence-based HIV/STI prevention strategies (e.g., 6 ART, PrEP, routine HIV/STI testing, condom use) are sub-optimal to reliably prevent acquisition and/or 7 transmission of HIV and other STIs given their current engagement in sexual risk behaviors. To date, no couples- 8 based HIV/STI prevention interventions are available in Lima or elsewhere in Peru. The overarching goal of the 9 proposed 3-year project is to help fill this critical gap in Peru’s HIV/STI prevention services. To start, we 10 conducted a mixed method pilot project to assess the acceptability of the PI’s theoretically-grounded eHealth, 11 couples-based HIV/STI prevention toolkit intervention with 42 cisgender male couples in Lima (14 concordant 12 HIV-negative, 16 discordant, 12 concordant HIV-positive). 90% of couples reported high acceptability of the 13 intervention, and liked the agreement builder activity the most. Couples told us they wanted more information 14 about HIV treatment as prevention (PrEP, ART, TasP/U=U) and how to strengthen and manage their own and 15 familial relationships (cultural context). They also wanted the intervention to be accessible on different web- 16 connected devices. Additional findings revealed only 33%-50% of couples included evidence-based HIV/STI 17 prevention strategies in their agreement. To help improve couples’ uptake and continued use of evidence-based 18 prevention strategies, our solution is to integrate an electronic algorithm into the agreement builder activity to 19 provide them with tailored recommendations that align with their engagement in sexual behaviors and 20 relationship profile. Methods: Via the proposed R34, our next steps are to apply the remaining stages of the 21 ADAPT-ITT model with elements of human-centered design to adapt our couples-based intervention. We will 22 then conduct a 6-month pilot RCT with a waitlist control to assess the feasibility, acceptability, and preliminary 23 impact of the adapted intervention with 60 cisgender male couples, stratified by their dyad HIV serostatus, on 24 outcomes of: a) formation and adherence to a tailored risk-reduction plan and agreement; b) relationship 25 functioning (e.g., communication); c) use of evidence-based HIV prevention strategies; and d) HIV/STI incidence 26 over time. Our proposed approach is rigorous with scientific premise as mixed methods and a pilot RCT with 27 a waitlist control will be used to achieve our Specific Aims. Our project is also timely and practical with key 28 stakeholder buy-in, suggesting the high Public Health significance of our proposal. Our findings will reveal the 29 feasibility, acceptability and preliminary impact of the adapted toolkit intervention to reduce couples’ HIV/STI risk 30 via sustained use of evidence-based HIV prevention strategies over time through their formation and adherence 31 to a tailored agreement and risk-reduction plan. Our next step will be to apply these findings (e.g., R01) to test 32 the intervention for efficacy. Our project is of interest to NOT-MH-20-019 and NOT-MH-20-020.