Cannabis use, PrEP and HIV transmission risk

Populations with elevated risk for HIV face a disproportionate burden of disease. Focused, high-coverage PrEP in populations heavily impacted by HIV could rapidly reduce new HIV acquisition rates; however, its uptake among at-risk populations has been limited. Therefore, we propose to conduct urgently needed research on PrEP in a cohort of PrEP-eligible participants, including on the impact of relevant behaviors, particularly cannabis use, which is highly prevalent in this population. Research on the impact of cannabis use on PrEP has achieved conflicting results, and it has not been rigorously studied in PrEP-eligible people. Therefore, the proposed R01 study will assess cross-sectional and longitudinal associations between cannabis use and PrEP outcomes (e.g., use, adherence) and HIV transmission risk (e.g. biological inflammation, sexual risk behavior) using event-level and objective biomarker data among HIV-negative people. To address these specific aims, we will conduct the Networks and Neighborhoods (N2) Cannabis PrEP Study in Chicago, IL. We will follow 250 HIV-negative participants from the original N2 cohort for an additional 2-year period with 5 study waves. We will use innovative and rigorous methods, to collect additional data, such as Ecological Momentary Assessment methods and objective measures of cannabis use, PrEP use, and immune function over 14-day periods at each wave. Potential findings can impact intervention development and implementation, as well as inform policy to increase PrEP uptake and adherence, address substance use, and decrease HIV transmission rates.