Development and Pilot RCT of a Telehealth-delivered Peer Navigation and Coping Skills Intervention to Increase PrEP Uptake and Adherence in Young Black Men who Have Sex with Men

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ABSTRACT Young Black men who have sex with men (YBMSM) ages 15-24 are heavily affected by HIV transmission such that, at current rates, it is estimated that about half of Black MSM in the US will be infected with HIV in their lifetime. Pre-exposure prophylaxis (PrEP) for HIV is a highly effective biomedical treatment which is up to 99% effective at preventing HIV when adhered to in a prevention-effective manner. This involves daily or event-based dosing of PrEP specifically during periods of risk of HIV exposure (i.e., prevention-effective (P-E) adherence). Despite interest, both uptake and adherence have been low among Young Black men who have sex with men (YBMSM) compared to other age and racial groups. The barriers to PrEP uptake and adherence among YBMSM are multifactorial and an effective intervention must be multilevel addressing both contextual and self-change processes to promote PrEP uptake and P-E adherence. An NICHD-funded study conducted in Boston found that peer navigation was highly acceptable for newly diagnosed HIV-infected youth; however, this study excluded youth without HIV and only focused on contextual structural barriers and did not address self-change processes. Notably, factors like medical mistrust and disclosure concerns among YBSM may affect self-change processes and impede PrEP use. Limited knowledge exists on how these factors may impede PrEP use; however, it is clear these barriers may be amenable to intervention using problem/emotion-focused coping strategies to facilitate PrEP uptake and P-E adherence for YBMSM. Unfortunately, interventions often limit participation to those willing and able to present to a research office. Despite prevalent economic stressors, more than 90% of YMSM of color in various studies have smartphones, thus telehealth and remote study procedures may facilitate participation by YBMSM at highest HIV risk. This proposal will adapt the NICHD peer navigation (adding coping skills and using telehealth) to be feasible, acceptable, and capable of supporting PrEP uptake and P-E adherence for YBMSM ages 15-24. YBMSM will be recruited online and from the Sydney Borum Jr. Health Center in Boston, which provides care to 1200 YMSM aged 12-29 annually, half of whom are Black or Latino. Over a proposed 5-year award period, in partnership with Massachusetts General Hospital and Fenway Community Health this project will: (1) Obtain qualitative knowledge on experiences of YBMSM and specify role of peer navigator in promoting PrEP uptake and P-E adherence, (2) Develop and iteratively refine the intervention, in consultation with a Community Advisory Board (CAB), and (3) Evaluate the technology-based peer navigation/coping skills intervention for feasibility and acceptability. This will be supported by training in adolescent health, qualitative methods, behavior measurement, and intervention science as well as general and underrepresented minority-focused career development. This approach is consistent with the NIH Office of AIDS Research goal of addressing mental health and structural comorbidities to facilitate biomedical prevention.