Implementation science to optimize HIV prevention and harm reduction among men who have sex with men engaged in transactional sex in the US

This five-year K01 Mentored Research Scientist Development Award will provide training and mentored research to move Dr. Atkins from her observational research portfolio to a research program designing and evaluating tailored strategies to address HIV and drug use among key populations, with a focus on men who have sex with men (MSM) engaged in transactional sex (MSM-TS). The award centers around training in (1) implementation science theory, frameworks, and designs; (2) HIV and harm reduction services supporting people who use drugs; (3) advanced qualitative and mixed methods research; and (4) implementation and evaluation of pilot trials. Supported by a team of expert mentors in these topic areas and in partnership with a leading provider of comprehensive support and services for individuals in Baltimore, Dr. Atkins will conduct a mentored research project to optimize harm reduction and HIV services for MSM-TS in Baltimore. In Baltimore, recent evidence shows 20% of MSM transact sex, and disparities in HIV and drug use outcomes are even more pronounced in this population. Among MSM, transactional sex has been associated not only with persistently high HIV burden but also with lower engagement with HIV testing and pre-exposure prophylaxis (PrEP) amid higher rates of condomless sex. Further, elevated drug use among MSM-TS has been associated with increased infection and overdose, but engaging MSM-TS with harm reduction has been a challenge. Few programs have been tailored to address the HIV and drug use syndemic among MSM-TS, despite a proliferation of evidence-based interventions that can support MSM-TS. Mitigating poor HIV and drug use outcomes associated with transactional sex and drug use therefore requires new strategies to engage MSM-TS with evidence-based HIV and harm reduction interventions. Guided by an ecological model, the Consolidated Framework for Implementation Research 2.0, and implementation mapping approaches, this mentored research project will aim to: (1) Contextualize multilevel influences on transactional sex, drug use, and health-seeking behavior among MSM-TS in Baltimore; (2) Apply implementation mapping to package strategies to improve harm reduction and PrEP uptake for Baltimore MSMTS; and (3) Assess the acceptability, feasibility, and preliminary efficacy of strategies to optimize the impact of MSH’s PrEP and harm reduction services for MSM-TS. The findings will inform development of a fully powered trial in real world settings to evaluate the implementation and effectiveness of the strategies, facilitating Dr. Atkins’s shift to intervention research and providing the necessary training and support for her to become a leading scholar in approaches to decrease HIV and drug-use associated morbidity and mortality in the US.