Assessing Psychosocial Predictors of PrEP Adherence and Persistence Among Young Black MSM

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Project Summary/Abstract Young Black men who have sex with men (YBMSM) continue to experience a disproportionate rate of HIV infections in the United States. HIV pre-exposure prophylaxis (PrEP) is a biomedical prevention intervention shown to reduce risk of HIV infection; however, studies suggest YBMSM are less likely to be prescribed PrEP and have significantly lower levels of adherence to PrEP compared to white MSM. PrEP use among YBMSM is estimated at between 3%-20%. In addition to concerns with adherence, persistence on PrEP among YBMSM is low, with discontinuation rates ranging between 17% to 22% within 6 months of starting PrEP. Psychosocial risk and protective factors might contribute to PrEP adherence and persistence among this population. Preliminary evidence suggests a relationship between PrEP adherence among YBMSM and psychosocial factors. Among YBMSM, stigma and low self-perceived HIV risk were cited as the most common reasons for PrEP refusal. However, it is not clear that these findings can be extended to adherence and persistence to PrEP among YBMSM because of the lack of the empirical data on the life cycle of PrEP use among YBMSM. Using a risk and resiliency framework, we will conduct a mixed methods study to understand the natural life cycle of PrEP use among YBMSM in Atlanta. The specific aims of the study are to characterize the patterns of PrEP adherence in the life cycle of PrEP use among YBMSM; identify and describe the psychosocial risk and protective factors to PrEP persistence and adherence; and identify intervention targets for a future PrEP adherence intervention. To achieve these aims, in Aim 1 we will follow 100 YBMSM newly-initiating PrEP for 6 months. Participants will complete weekly assessments of their PrEP use and sexual behavior weekly for the first 90 days and then monthly thereafter. Quarterly, participants will also complete assessments of psychosocial domains (depressive symptomatology, substance use, social support, perceived HIV risk). Adherence will be captured using a self-report item and confirmed via self-collected dried blood spot (DBS) testing at three and six months. In Aim 2, up to 40 YBMSM will complete in-depth individual interviews (IDIs) describing their experiences using PrEP, highlighting their decisions about daily adherence and the psychosocial risk and protective factors that contributed to their levels of adherence and persistence or discontinuation of PrEP. Lastly, drawing upon the psychosocial risk and protective factors associated with PrEP discontinuation and PrEP persistence in Aim 1 and the content and examples from individual interviews in Aim 2, in Aim 3 we will identify psychosocial intervention targets associated with PrEP adherence. This study will lay the foundation for the development of interventions to support PrEP adherence and persistence among this population.