3T-Prevent: Piloting a multi-level, combination intervention strategy to expand HIV and bacterial STI prevention

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PROJECT SUMMARY In the U.S., incidence rates of HIV and bacterial sexually transmitted infections (BSTIs) are disproportionately high among gay, bisexual, and other men who have sex with men—referred to herein as sexual minority men (SMM)—compared to men who have sex with women only. Roughly 10% of HIV incidence is attributable to increased transmission due to untreated active chlamydia and gonorrhea infections among SMM, and 64% of syphilis cases occur among SMM. Oklahoma is an Ending the HIV Epidemic priority rural state with above average yearly cases of chlamydia and ranks in the top 10 for gonorrhea and syphilis infections nationwide. Moreover, there has been an overall upward trend in HIV incidence among SMM in Oklahoma over the past five years. An estimated 17.1% of HIV incidence among SMM is likely to be averted with doubling of HIV pre- exposure prophylaxis (PrEP) coverage, and the expansion of HIV and syphilis testing can aid in treatment as prevention. Additionally, patient-delivered partner therapy (PDPT) is a method of BSTI prevention where patients diagnosed with chlamydia or gonorrhea are provided medication to give directly to their partners. Concerns about PDPT have centered around missed opportunities for HIV and syphilis testing, which could be alleviated by including HIV and syphilis self-testing kits with PDPT. Additional synergy is to pair PrEP with BSTI diagnoses and PDPT since SMM diagnosed with BSTIs are priority candidates for PrEP. During Aim 1, we will form a Community Advisory Board comprised of SMM (including racial/ethnic minorities and rural SMM), healthcare providers, community advocates, and other stakeholders in Oklahoma. Working in collaboration with this group, we will develop an intervention called 3T-Prevent with iterative refinement based on community feedback from SMM (n = 20) and key informants (n = 20; clinicians, nurses, clinic managers, and other stakeholders). Preliminary intervention activities include detailing clinics and providers to support distribution of HIV and syphilis self-testing kits with PDPT to SMM for investigational purposes only; training and telementoring providers to deliver theoretically guided counseling sessions to support self-testing, PDPT, and PrEP use among patients and partners; and optimizing PrEP prescribing/referrals and linkage to HIV care. We will pilot and evaluate the finalized intervention in three clinics in varied settings of Oklahoma that offer HIV/BSTI testing services using a hybrid type-1 effectiveness-implementation design via a stepped-wedge randomized controlled trial to mimic a future statewide implementation strategy. We will concurrently recruit clinic directors (n = 3) and providers (n = 9) and 108 SMM within the three clinics. RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) evaluation will be assessed using convergent mixed-method analysis of surveys (clinic directors, providers, and SMM patients), electronic medical records, and exit interviews to assess feasibility, acceptability, and preliminary impact.