PrEP uptake, adherence & retention for African American MSM in Mississippi

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 DESCRIPTION (provided by applicant): Young, African American men who have sex with men (YMSM) in the Deep South are disproportionately impacted by the HIV/AIDS epidemic. A once daily medication (emtricitabine/tenofovir) known as pre-exposure prophylaxis (PrEP) can dramatically reduce HIV acquisition among MSM but behavioral and social challenges undermine its optimal uptake, use and efficacy. This proposal by early stage investigators develops and tests a pilot intervention designed to enhance PrEP adherence and retention in care for AA YMSM in Mississippi. The findings of this research will be used to help define the essential elements of a prevention intervention to overcome barriers to PrEP adherence and retention in care among AA YMSM, and will be uniquely tailored to the social and health policy contexts relevant for African American men in the Deep South. In 2014, to respond to unmet need for HIV prevention services among AA MSM in the Deep South, our group established the first PrEP program in Jackson, Mississippi. Our clinical and implementation experience to date highlights several challenges and barriers that impede optimal PrEP adherence and retention in care for PrEP, and informed the following specific aims: Aim 1: Qualitative analyses will explore: 1) acceptability of improving PrEP uptake by engaging AA YMSM through mobile location-based phone and internet applications ("apps") (where nearly half of AA YMSM in Jackson, MS meet sexual partners); 2) sexual risk behaviors, including with partners met online vs. other venues, frequency of app use, and proportion of sexual encounters from specific geographical areas relative to where participants live; and 3) acceptability of potential intervention components and related content to support PrEP adherence and retention. Results will inform development of a context-specific, real-world PrEP intervention for AA YMSM in the South. Aim 2: To conduct an open pilot evaluation of the retain and adhere African American Men on PrEP (RAMP) intervention with up to 10 AA HIV-uninfected YMSM. Using an iterative process of implementation, feedback and continuing quality improvement over six months, we will improve acceptability and feasibility of this intervention. Aim 3: To conduct a pilot randomized control trial of the RAMP intervention among 80 AA HIV-uninfected YMSM. Participants will be randomized to either the RAMP intervention or a standard of care arm. The RAMP intervention will include patient assistance services for PrEP and related follow-up care, including: enhanced counseling, appointment reminders, assistance with overcoming insurance and other barriers to PrEP related services, and transportation assistance. Primary outcomes will include PrEP adherence and retention in PrEP related medical care.