Young men who have sex with men (YMSM) and transgender women (YTW) aged 18-29 remain at high risk for HIV infection, particularly YMSM and YTW of color. Such disparities cannot be attributed to individual-level behaviors alone. Age and racial disparities have been associated with a number of social determinants of HIV, including: limited awareness, low perceived risk, small sexual networks with high density of STIs and HIV, inadequate access to HIV prevention services, and more recently poor PrEP awareness, knowledge, access, and uptake. Although PrEP is available and approved for adults ages 18 and older, demonstration studies show that less than 15% of current PrEP users identify as Black. In a Chicago-based study, by Schneider et al., only 41% of Black YMSM and YTW surveyed were aware of PrEP, only 12% knew someone who had taken PrEP, and only 4% had used PrEP. PrEP awareness was significantly associated with having a primary care provider, participation in HIV programs or studies, having had a STI screening, and being a member of the House & Ball community. However, in 2009 only 1% of primary care providers reported ever prescribing PrEP, this increased only to 7% by 2015. Thus, although PrEP is a promising biomedical intervention for HIV prevention, its uptake among Black YMSM and YTW, two groups at risk for HIV, appears to be undermined by critical contextual factors?awareness, knowledge, and access. Innovative, low-cost, scalable structural-level interventions that address these barriers and engage hard-to-reach populations, are needed to maximize PrEP?s potential for impacting the HIV epidemic. The proposed study seeks to develop and pilot-test a novel structural-level community pharmacy-based PrEP intervention that includes: (1) the development of a digital PrEP information kiosk, and (2) PrEP educational training and referral system for pharmacy staff. The ubiquity, accessibility, and potential for non- stigmatized, population-directed PrEP information and consultation access make community pharmacies an important venue for exploration. Ultimately, this intervention has the potential to reach and engage a large number of eligible PrEP users who might not necessarily be connected with other HIV prevention programs or venues where PrEP information is disseminated (e.g., House & Ball, LGBT). The proposed study is responsive to the NIH HIV/AIDS high priority topic by specifically addressing health disparities in the incidence of new HIV infections and access to treatment. Further, this proposal includes populations at elevated risk for HIV infection and addresses health and social issues that are clearly linked with HIV. Study findings will directly lead to a subsequent multi-site pharmacy randomized controlled trial of the pharmacy-based PrEP intervention kiosk and pharmacy staff educational training for increasing PrEP awareness, knowledge, and initiation among Black YMSM and YTW.
Young men who have sex with men (YMSM) and transgender women (YTW) aged 18-29, particularly those of color, are at high risk for HIV infection. The proposed study will develop and pilot test a novel pharmacy-based intervention that employs a digital information kiosk and educational training and referral system located in local community pharmacies to encourage improved provision of information on pre-exposure prophylaxis (PrEP) in populations at high risk for HIV infection.
