The overall goal of this K23 proposal is to provide Latesha Elopre, MD, MSPH the essential mentorship and career development necessary to become an independent investigator whose research will contribute to decreasing health inequity among underserved and disproportionately impacted populations regarding HIV infection rates. The initial focus of her work will be in developing a behavioral intervention to increase uptake of HIV pre-exposure prophylaxis (PrEP) among young, Black men who have sex with men (MSM) in the Deep South. Currently, the Centers for Disease Control and Prevention estimate that 50% of black MSM will become infected with HIV in their lifetime. Furthermore, the Southern United States is seeing the highest rates of new HIV infections in this population, with rates rapidly increasing for young, black MSM. Through consistent use of PrEP, a biomedical prevention tool, decreased HIV infection rates can be seen among young, Black MSM. Research focusing on increasing HIV prevention services and decreasing health disparities in HIV incidence have been high priority for the NIH. However, there have been few studies evaluating PrEP uptake among young, Black MSM in the Deep South. In concordance with prior research that has shown individual and structural factors leading to increased stigma and marginalization for black MSM, this study will be grounded in the Andersen Behavioral Model for Healthcare Utilization with subsequent individual level intervention driven by the situated Information, Motivation and Behavioral skills theoretical framework. This conceptual model will allow for investigation of core determinants of health behavior in the context of individual and societal barriers influencing health service utilization. A mixed-methods research design will aid in targeted intervention development with a more granular understanding of potential barriers for PrEP uptake. Hypothesis: Characteristics that pertain to stigma related to PrEP, HIV, race, religion and poverty as well as healthcare access will be major barriers to awareness and uptake of PrEP for young, Black MSM in the South.
The specific aims for this research proposal are as follows:
Aim 1 : Determine critical beliefs and attitudes regarding PrEP awareness and uptake among young, Black MSM in the South.
Aim 2 : Determine environmental barriers for delivery of PrEP to young, black MSM in the South.
Aim 3 : Develop a targeted intervention to increase PrEP uptake among young, Black MSM in the South. With guidance from my mentorship team, a career development plan has been created to gain training in behavioral theory, intervention development and mixed-methods research design enabled by additional coursework, hands on training, seminars and national workshops. Upon completion of the proposed scientific aims, I will be poised to pilot a theory-guided behavioral intervention to enhance PrEP uptake among young black MSM in the U.S. Deep South supported by an R-series grant.
Disproportionately high numbers of HIV infection are seen among young, Black men who have sex with men (MSM) who live in the Southern United States. New estimates from the Center for Disease Control and Prevention predict 1 in 2 Black MSM will be infected with HIV in their lifetime. Biomedical HIV prevention strategies, such as HIV pre-exposure prophylaxis (PrEP), have been shown to effectively decrease rates of HIV infection by up to 92% with consistent use. The project described in this application will develop a theory- driven behavioral intervention, utilizing a mixed-methods research design, to increase uptake of PrEP among young, Black MSM in the South.