SNS and PrEP Initiation and Adherence in Black SMM

Specific Aim 1. Conduct 18 focus groups among Black gay, bisexual and other sexual minority men (SMM; n=72-90) in the Washington, DC area of different age groups (18-24, 25-34, 35+) and various pre-exposure prophylaxis (PrEP) use profiles (i.e., PrEP naïve, current PrEP users, and discontinued PrEP; two per age-group and PrEP use profile) to understand intervention feasibility, acceptability and appropriateness, how the intervention can address experienced and perceived socio-structural barriers, and increase PrEP initiation and adherence among Black SMM in the Washington, District of Columbia (DC) area. Specific Aim 2. Implement an iterative open-phase pilot of an SNS intervention to increase PrEP initiation among human immunodeficiency virus (HIV)-negative Black SMM, aged 18 years and above, in the Washington, DC area. Recruit 30 PrEP-using Black SMM, including those who use substances, as Recruiters to identify and refer Network Associates to PrEP services. The pilot will occur in six blocks of up to 5 Recruiters to further develop all intervention procedures and enhance the social networking strategy (SNS) intervention's feasibility and acceptability.

The first 12 months (Phase 1: Formative Research) will be an intervention development/adaptation phase. Using a community-based participatory approach (n=18 age- and PrEP use profile-specific focus groups, of at least 4-5 participants each, totaling 72-90), participants will be asked about the social network dynamics and characteristics (e.g., influential network members, communication about PrEP as an HIV prevention method) that influenced their decision to initiate PrEP. Among participants with no PrEP use, they will be asked about the acceptability and feasibility of talking with PrEP-using Black SMM within their respective social network to support initiation along with preferences for relevant PrEP-related information from peers. The following 12 months (Phase 2: Open-phase Pilot Study) will involve conducting an open pilot of the SNS intervention, in up to six batches of up to 5 participants (n=30), allowing for further intervention refinement. This will allow us to demonstrate participant feasibility and acceptance, which includes the ability to recruit network members, feasibility of intervention delivery, and changes in participant behaviors. It will allow for further evaluation of the feasibility of all study procedures, and refinement of intervention manual. Therefore, the expected outcome is a culturally relevant SNS intervention to increase PrEP initiation among Black SMM through PrEP-using social network members.