Promoting linkage to PrEP after HIV self-testing through a peer-led intervention for MSM

Project Summary Ending the HIV epidemic will require novel strategies to expand the HIV prevention continuum among men who have sex with men (MSM), who are disproportionately affected by HIV. The COVID-19 pandemic has underscored the need for remote care approaches such as HIV self-testing (HIVST) to sustain access to HIV services. However, the benefits of self-testing are limited if they do not spur behavioral change or linkage to care, yet only 1 in 10 MSM who self-test obtain preventive care afterwards, and the majority of MSM with indications for PrEP have never used it. Interventions to support linkage from HIVST, the first key step in the HIV “status neutral” continuum, are needed. To maximize the impact of HIVST, linkage to care is a critical practice gap that needs to be addressed, a gap that can potentially be bridged by a peer intervention to support linkage and PrEP uptake. To expand the HIV prevention continuum among MSM, this research will leverage HIVST and evaluate a peer-led intervention to support engagement in care and PrEP uptake through peer linkage after self-testing. The overall goal of this career development award is to provide Dr. Cedric Bien- Gund with the necessary research skills to become an independent clinician-investigator in the development, evaluation, and implementation of behavioral interventions to prevent HIV infections. To achieve this goal, we have assembled a mentoring team and proposed a rigorous training plan to develop his skills in 1) mixed methods for behavioral interventions, 2) intervention design and mapping for implementation, and 3) advanced clinical trial design, including implementation science designs. These training objectives complement a research plan to develop and pilot a behavioral intervention to increase linkage to PrEP among MSM through integration of HIVST distribution and peer-led linkage to PrEP. The specific aims are: 1) identify barriers and facilitators to PrEP linkage after HIV self-testing among MSM, 2) develop a peer-led linkage intervention for HIVST, and 3) test the acceptability, feasibility, and preliminary efficacy of the intervention on PrEP linkage and uptake among MSM by conducting a pilot randomized controlled trial. This project will leverage an ongoing collaboration with the Philadelphia Department of Public Health to expand HIVST and PrEP uptake. The proposed research addresses the first steps in the HIV prevention continuum and will support Dr. Bien-Gund's goal of becoming an independent investigator with expertise in behavioral interventions to end the HIV epidemic. This research will provide preliminary data for an R01 application to test the intervention in a hybrid type I effectiveness-implementation trial, with the goal of optimizing the impact of HIVST by closing the linkage gap after testing.