Estimating the Impact of a Multilevel, Multicomponent Intervention to Increase Uptake of HIV Testing and Biomedical HIV Prevention among African-American/Black Gay, Bisexual and Same-gender Loving Men

ABSTRACT Increasing access to and uptake of biomedical prevention (PEP/PrEP) is critical to ending the epidemic in the United States (US) among gay, bisexual and other men who have sex with other men (MSM). This is particularly true for urban, African-American or Black MSM, who are disproportionately affected by HIV and would thus benefit from more HIV testing, which is now recommended every 3-6 months for key groups and is the gateway to treatment and prevention. NYC is the metropolitan area in the US with the largest number of newly diagnosed HIV infections among MSM and 89-94% of all people living with HIV/AIDS (PLWHA) in the US reside in urban areas. Although such urban areas often have robust testing and PEP/PrEP dissemination programs, consistent testing and PEP/PrEP uptake is unacceptably low among urban-dwelling Black MSM. There is thus a need for interventions to support both HIV testing and PEP/PrEP uptake by accelerating existing implementation and dissemination efforts. Most HIV testing and PEP/PrEP uptake interventions focus on individual-level navigation of system/structural barriers and/or cognitive antecedents (intentions, motivation, skills) to behavior; few focus on reducing stigma/discrimination-related barriers to testing/PEP/PrEP via self-testing, empowerment, peer support and community norms. To fill this gap, we propose to test an intervention composed of evidence-based and novel intervention components, designed by our study team, that operate at multiple levels and can be integrated into CBO-delivered HIV prevention programming to support HIV testing and PEP/PrEP uptake. We will estimate additive and interactive effects of the components, that include a single-session, peer-based HIV self-testing component, a three-session PEP/PrEP navigation enhancement component, and a social and print anti-intersectional stigma media campaign, using factorial and quasi-experimental designs. The primary outcomes are HIV testing (while not on PrEP/PEP) and PrEP uptake. Secondary outcomes include consistent HIV testing (2+ tests at least 3 months apart in 9 months); PEP uptake; PrEP/PEP adherence (self-report/medical record/urine test). To achieve the study aims, we will enroll 480 PrEP-eligible Black MSM (aged 18-55) living in Central Brooklyn into the study and randomize them to one of four study arms and follow them over 18 months. Our study, which represents a collaboration between a community-based organization currently engaged in PEP/PrEP uptake programming and an academic research team, is designed to identify the added value of components that operate at different levels and are designed to increase individual-level HIV testing and biomedical HIV prevention use among a group highly vulnerable to HIV.