Neighborhood and digital immersion effects on PrEP adherence through a digital intervention in young sexual and gender minorities who have sex with men

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Project Summary Young sexual and gender minorities who have sex with men (YSGMSM) carry a disproportionate burden of the HIV epidemic in the United States, yet Pre-Exposure Prophylaxis (PrEP) uptake and adherence has been inadequate for these groups. Research into HIV syndemics has illuminated the importance of social and structural factors for HIV risk, yet the research into HIV syndemics for YSGMSM has been limited to individual level survey measures. A parallel line of research has used multilevel models to explicitly model neighborhood factors, however no research to date has applied this modeling technique to understand the direct relationship between social and structural neighborhood factors and PrEP adherence. Similarly, immersion in digital spaces (e.g., consumption of social media) can influence HIV risk as well. Despite interventions for PrEP uptake and adherence being increasingly delivered through digital devices, some of which utilize digital support communities and the growing culture of digital communication among youth, including YSGMSM, no studies to date have characterized how digital immersion influences PrEP adherence through a digital PrEP intervention. Finally, it has been shown that joining non-digital support groups can mitigate neighborhood factors in YSGMSM and reduce sexual risk behaviors suggesting that a digital PrEP intervention might have the same capability but with more reach. For these reasons, this research will examine how convergent digital and neighborhood factors impact PrEP adherence in YSGMSM by leveraging iTech’s P3 study, an NICHD-funded randomized controlled trial (RCT) to improve PrEP adherence among YSGMSM. This three arm RCT is designed to assess the effectiveness of P3 and P3+ to improve PrEP adherence among 246 16-24 year-old YSGMSM across nine US study sites. The study collects residential zip code, allowing for examination of neighborhood effects on PrEP adherence. Through mentored training in social and structural neighborhood determinants of PrEP adherence in YSGMSM, multi-level models, mediation analysis, causal inference, and professional development activities, the proposed F31 will achieve the following specific aims: 1) Characterize how neighborhood syndemic risk relates to PrEP adherence in YSGSM, 2) Identify how immersion in digital spaces and communities outside P3’s intervention influence engagement inside P3’s intervention, and subsequent PrEP adherence, 3) Determine how the P3 intervention condition attenuates the relationship between syndemic neighborhood and digital immersion factors’ impact on PrEP adherence. These aims will enrich our understanding of how digital and neighborhood factors impact PrEP adherence, a critical step in precision preventative health against HIV for YSGMSM. This aligns NICHD priorities for adolescent HIV prevention with the Ending the HIV Epidemic in the US by 2030 Initiative.