HIV disparity persist among Latino men who have sex with men (MSM), especially those who are immigrants. The CDC estimates the lifetime HIV risk is 1 in 5 for Latino MSM compared to 1 in 11 for white MSM. Pre-Exposure Prophylaxis (PrEP) is a biomedical strategy highly effective in preventing HIV acquisition, with the potential to reduce the number of new HIV infections among Latino MSM in the U.S. PrEP involves once daily dosing of medications. The FDA has approved two medications, sold under the brand names Truvada and Descovy for daily use as PrEP. The Centers for Disease Control and Prevention (CDC) has established clinical guidelines for administering PrEP to high-risk candidates. While evidence indicates that PrEP use is rising in the U.S., disparities persist in uptake among Latino MSM, despite their reported high levels of interest in using PrEP. To address this disparity, we propose a 2-phase project to develop a pilot PrEP intervention called Estoy PrEParado (I'm PrEPared) to facilitate initiation and adherence to PrEP among immigrant Latino MSM. The project will develop an engaging, culturally tailored intervention using the Information-Motivation-Behavioral Skills (IMB) model.
The specific aims of the project are:
Aim 1 : based on data from a prior study, the project will elicit feedback, validation and modification to the initial content areas of the Estoy PrEParado intervention to facilitate PrEP adoption and adherence among immigrant Latino MSM;
and Aim 2 : the project will conduct a small randomized pilot of Estoy PrEParado to assess the feasibility, acceptability and preliminary impact of the intervention in moving immigrant Latino MSM along the PrEP cascade to initiation. In formative phase 1, the project will use the innovative and novel World Caf approach to facilitate a community conversation with immigrant LMSM (n?40) to validate, modify and refine the initial intervention content areas of the Estoy PrEParado pilot intervention. The World Caf is a powerful conversational process for facilitating constructive group dialogue that produces ideas and knowledge that can be put into practice. The project will also elicit feedback and input on the contents of the intervention from a project-specific Intervention Advisory Committee (IAC) comprised of academic and community experts. In phase 2, the project will conduct a small randomized pilot of 80 participants (40 participants receiving the PrEP intervention and 40 participants receiving standard care, i.e., PrEP referrals) to establish feasibility, acceptability and preliminary impact. If the intervention shows promise, the findings will support the preparation of a larger scale R01 efficacy trial.
For Public Health, it is important to facilitate adoption of PrEP, a highly effective biomedical HIV prevention strategy that can help reduce new HIV infections among immigrant Latino MSM in the U.S. Our study will make use of HIV testing sites as an entry point to enroll participants into our pilot PrEP intervention with information tailored to address the specific needs of immigrant Latino MSM who are considering PrEP for HIV prevention. The insights from this R34 grant will serve as the basis for a subsequent R01 grant application to assess efficacy of the intervention.
