A Randomized Trial of a Brief Behavioral Intervention for PrEP Uptake Among Men Who Have Sex With Men at Increased Risk for HIV Infection

Philip A. Chan, MD, MS; Amy Nunn, ScD; Jacob J. van den Berg, PhD; Kevin Cormier, BS; Genoviva Sowemimo-Coker, MPH; Siena C. Napoleon, MPH; Trisha Arnold, PhD; Ethan Moitra, PhD

Disclosures

J Acquir Immune Defic Syndr. 2021;87(3):937-943. 

In This Article

Abstract and Introduction

Abstract

Background: The aim of this study was to evaluate the efficacy of a novel, brief 2-session behavioral intervention to promote HIV pre-exposure prophylaxis (PrEP) uptake among men who have sex with men (MSM) who are behaviorally at risk for HIV.

Setting: A pilot randomized controlled trial was conducted at a sexually transmitted infection (STI) clinic to compare a brief motivational interviewing intervention with passive referral only for PrEP uptake.

Methods: MSM who scored as "high risk" on the HIV Incidence Risk index for MSM was offered a brief (15–20 minutes) motivational interviewing–based intervention at the time of STI testing to address barriers to PrEP uptake, including low risk perception, stigma, side effects, and cost. The initial session was followed by a brief, telephone booster session that lasted <10 minutes. The primary outcome was attending a clinical PrEP appointment and accepting a prescription for PrEP.

Results: Participants were recruited from an urban STI clinic in the United States. A total of 86 MSM who were behaviorally at risk for HIV were enrolled in the study (N = 43 intervention; N = 43 treatment-as-usual, "TAU"). Participants randomized to the intervention were significantly more likely to attend a clinical appointment and accept a prescription for PrEP, compared with treatment-as-usual (52.3% versus 27.9%, respectively; odds ratio = 3.6; 95% confidence interval: 1.5 to 8.9; P = 0.005).

Conclusions: A brief behavioral intervention focused on the initial steps in the PrEP care cascade demonstrated preliminary efficacy in promoting uptake among MSM who are behaviorally at risk for HIV.

Introduction

HIV continues to be a significant cause of morbidity and mortality in the United States (US) with a disproportionate number of infections among gay, bisexual, and other men who have sex with men (MSM).[1] Pre-exposure prophylaxis (PrEP) has demonstrated efficacy in preventing HIV infection[2–5] and has the potential to significantly reduce HIV incidence in populations at risk, such as MSM. The Centers for Disease Control and Prevention estimated in 2015 that nearly 25% of sexually active MSM meet indications for PrEP.[6] Despite significant increases in PrEP awareness among MSM since this time, PrEP use remains suboptimal, particularly for African American/Black and Hispanic/Latinx MSM.[7] Given this, novel approaches to improve PrEP uptake are needed.

Significant barriers to PrEP uptake include low perceived HIV risk, stigma, concern for side-effects, and cost.[8–11] Of these, low perceived HIV risk has emerged as a significant challenge. Up to 37% of MSM presenting to a sexually transmitted infection (STI) clinic who reported condomless anal sex did not perceive themselves to be at-risk for HIV infection.[12] This has been observed across multiple other studies.[13,14] Misperceptions about side effects and lack of awareness of programs to defray cost and minimize out-of-pocket expenses have also led to lower PrEP uptake.[15–17] Despite knowledge of these myriad barriers, few interventions have successfully increased PrEP uptake.

This goal of this study was to develop and evaluate the feasibility, acceptability, and efficacy of a novel behavioral intervention to promote PrEP uptake among MSM at increased risk for HIV at an STI clinic who were not already seeking PrEP. The intervention was designed to be brief and applicable in a busy clinical setting. We hypothesized that the intervention, relative to usual clinical care, would result in the following: (1) increased willingness to schedule a PrEP evaluation appointment, (2) increased likelihood to attend the appointment, and, (3) increased likelihood to accept a PrEP prescription.

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