Black MSM in the US are affected by HIV at severely disproportionate rates. A key component of HIV prevention for communities at risk is increasing access to and uptake of biomedical HIV prevention, including pre- and post-exposure prophylaxis (PrEP/PEP). PEP is underutilized by those at risk for HIV acquisition after exposure, despite the fact that Centers for Disease Control and Prevention (CDC) issued the first PEP guidelines over 15 years ago. Numerous barriers to successful PEP treatment exist along the PEP cascade for Black MSM. Research on the PEP cascade and barriers is sparse, with almost none focused solely on Black MSM. Increasing access to and uptake of PEP among Black MSM has the potential to reduce racial disparities in HIV incidence. To address this gap, we propose to evaluate the acceptability and feasibility of a multi- component intervention designed to increase awareness of, demand for, and access to PEP among Black MSM at high risk of HIV infection. The intervention has three components: 1) a social media campaign to increase demand for PEP among Black MSM; 2) a 24-hour helpline to link patients to timely clinical care; and 3) a PEP advocate intervention, modeled on peer health navigation, to ensure medication access and sustain engagement. The research will involve three phases. In Phase 1, we will conduct formative research to inform the media campaign and the PEP advocate intervention. In Phase 2, we will translate the results of the formative research into optimal messaging across relevant social and print media and standardize the PEP advocate intervention. In Phase 3, to assess impact of the media campaign, we will evaluate social media metrics and calls to the helpline. To assess the acceptability, feasibility and preliminary impact of the PEP advocate intervention, we will survey the first 50 eligible helpline callers and all patients accessing PEP at the clinical study site at 1-week and 3-months post exposure to describe the following outcomes: PEP uptake and completion, PEP care engagement, incident HIV and STIs, HIV testing, PrEP use, sexual risk behavior, select psychosocial factors and receipt of health services.
New HIV infections among gay, bisexual and other men who have sex with men (MSM) aged 13 to 24 increased by 133% between 2001 and 2011 in the United States (US) and HIV disproportionately affects Black MSM; a recent study reporting a 5.9% annual HIV incidence among Black MSM (aged 18-30) in 6 US cities. Post-exposure prophylaxis (PEP) can prevent infection among Black MSM, but is underutilized. This study propose to evaluate the acceptability, feasibility and preliminary impact of a multi-component intervention designed to increase awareness of, demand for, access to and uptake of PEP among Black MSM at high risk of HIV infection. Increasing uptake of biomedical prevention methods such as PEP is critical to reducing the disproportionate disease burden in African American and Black communities.
