PrEP2Prevent An Online PrEP Navigation and Activation Intervention
Study Details
Study Description
Brief Summary
FThis NIDA-funded research study, entitled, PrEP2Prevent: An Online PrEP Navigation and Activation Intervention for YMSM, will develop and pilot test a PrEP activation, navigation and support intervention for young men who have sex with men (YMSM); this population not only has the highest annual incidence of HIV, but also is the least likely to have ever used PrEP. Our own data with a large cohort of YMSM indicates that while 90% have heard about PrEP and 86% meet CDC's eligible criteria for PrEP, only 23% have ever used PrEP and 8% are currently on PrEP. In this same cohort, 26% tested positive for one or more sexually transmitted infections (STIs) and the HIV seroconversion rate was 4.3% during a 2 years period. Thus, it is very clear that there is an urgent need for interventions that specifically target PrEP uptake while also addressing a complex array of individual (e.g. substance use, depression), sociocultural (e.g., PrEP-related stigma), and structural (e.g., medication costs) barriers to PrEP uptake. The investigators are proposing an intervention that includes PrEP navigation; patient activation to reduce PrEP-related stigma and increase PrEP self-efficacy; and peer/social support. The intervention will be delivered using mobile health (mHealth) or similar technology.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
The U.S. Department of Health and Human Services (HHS) has set a goal to end the HIV epidemic by the year 2030, which is well within reach given the availability of antiretrovirals that effectively prevent and treat HIV. But success can only be achieved if targeted approaches are implemented with at-risk populations to address known barriers of engagement along the pre-exposure prophylaxis (PrEP) and HIV care continua. In response, obtained funding from NIH, using the R34 mechanism, with the goal of the research being to develop and pilot test a PrEP activation, navigation and support intervention for YMSM, including young Black and Latino YMSM (B-YMSM, L-YMSM), who not only have the highest annual incidence of HIV but who are also the least likely to have ever used PrEP. There is very clear evidence demonstrating that while YMSM have high levels of knowledge about and intentions to use PrEP, few have ever used PrEP. Our own research demonstrate the urgent need for interventions that specifically target PrEP uptake while also addressing a complex array of individual (e.g., side effect concerns, substance use, depression), sociocultural (e.g., internalized homophobia, PrEP-related stigma), and structural (e.g., access to care, medication costs) barriers to PrEP uptake. Our research also demonstrates that such an intervention should include four components: 1) inclusion of PrEP and other service navigation; 2) provision of skills to address patient activation, reduce PrEP-related stigma, and increase PrEP self-efficacy; 3) peer/social support; and 4) utilize a mobile health (mHealth) platform or similar technology that supports both in-person and virtual intervention delivery (text and live video chat). Based on these findings, the investigators propose to conduct research with the following specific aims
Specific Aim 1: Conduct formative research to inform the development of a PrEP activation, navigation and support intervention, which the investigators call PrEP2Prevent. Qualitative data will be collected using structured guides from working/focus groups with YMSM, Trans, and gender non-conforming youth and during Key Informant Interviews (KII) with existing PrEP care providers/navigators. These data will inform intervention content and activation/navigation services.
Specific Aim 2: Develop and then conduct usability testing of PrEP2Prevent, including both the intervention content and mHealth delivery platform. Data from Aim 1 will inform the content and structure of intervention components to be included. During intervention development, two rounds of usability testing will be conducted with 8-10 YMSM, Trans, and gender non-conforming youth to ensure features are usable and the content is understood. Internal beta testing will be performed to assess for full technical functionality.
Specific Aim 3: Evaluate the feasibility, acceptability and preliminary efficacy of PrEP2Prevent with a racially/ethnically diverse sample of 150 (50 Non-Hispanic Whites, 50 Blacks/African American, 50 Latino/Hispanic) YMSM, Trans, gender non-conforming youth, ages 16-26 years. Participants will be randomly assigned in a 1:1 ratio to the intervention app (PrEP2Prevent) or control app (standard of care). Primary outcomes are feasibility, acceptability and preliminary efficacy. Feasibility data will include sources and rates of recruitment/retention, barriers and facilitators to recruitment/retention, engagement with PrEP navigator both in-person and via mHealth platform, as well as paradata on the mHealth platform use (e.g., number of log-ins, time spent, chatroom/text-based discussions). Acceptability will be assessed using a survey with validated measures at intervention completion. Preliminary efficacy will include linkage to PrEP services and PrEP uptake, these data will be collected at baseline and at 3- and 6-months following completion of the intervention. Mediators/moderators will include PrEP self-efficacy, PrEP stigma, and patient activation. The findings from this research will inform further refinements to the intervention and provide estimates of possible intervention effect sizes (group means, SDs) for a future randomized controlled trial (RCT). The funded research is highly significant, timely and innovative. Its innovation lies in the fact that it: a) targets an intervention for YMSM where it is most needed - e.g., on PrEP uptake; b) recognizes that YMSM require tools and support to successfully navigate PrEP services; and c) uses mHealth to deliver the intervention. Moreover, the intervention can be used for both engagement and re-engagement in PrEP uptake for YMSM who cycle in and out of PrEP care. Further, the intervention is potentially easily adaptable and transferable to address other critical PrEP and HIV needs (e.g., uptake of long-acting PrEP and antiretroviral therapy [ART]).
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| No Intervention: Control Access to mobile health platform for resources and information about PrEP |
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| Experimental: Experimental Access to mobile health platform for resources and information about PrEP plus sessions with peer health support navigator, social app interactions, goal setting capabilities |
Behavioral: PrEPresent
PrEP2Prevent is being done in several phases (parts) to develop and pilot test a PrEP activation, navigation and support intervention for young men who have sex with men (YMSM), trans youth and non-binary youth in Los Angeles. It targets an intervention for these young people where they need it most - on PrEP uptake. PrEP stands for pre-exposure prophylaxis.
Other Names:
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Outcome Measures
Primary Outcome Measures
- Formative Research - PrEP Provider and Navigator Interviews [90 minute one time interview]
16 qualitative interviews with PrEP Providers and Navigators will be recorded and transcribed. Using existing theory or prior research, researchers will begin by identifying key concepts or variables as initial coding categories. MAXQDA will provide support in the coding and the ability to better understand and identify emergent themes and conceptual frameworks through network maps. These maps may include: 1) components most relevant for an intervention; 2) effective strategies for activation, motivation and engagement; 3) attitudes and challenges related to PrEP; 4) differences in needs, challenges and expectations across ethnic groups; and/or 5) most relevant/important mHealth features. The maps will then be analyzed to identify the relationships between constructs related to the PrEP cascade and relevant components of an online PrEP navigation model.
- Formative Research - Youth Working Groups [4 week duration]
Two working groups, each with 6-10 racial/ethnically diverse YMSM, Trans, and gender non-conforming youth will be conducted. Working groups will meet weekly (or bi-weekly) for up to four sessions. Participants will be guided in discussions on a variety of topics, including 1) experiences with perceptions of PrEP; 2) understanding how YMSM, Trans, and gender non-conforming youth access care; 3) factors that impact uptake of and use to PrEP; 4) risk perceptions and health as a priority; 5) preferred modality (mobile app, web-based, online chat/video) and frequency of navigation activities; and 6) strategies to increase patient activation self-efficacy, advocacy, motivations). A baseline survey about personal health, health history and technology will be given to participants before their first session. At the end of each session, a satisfaction survey will be given to participants to fill out.
- Pre-Pilot Mobile App Usability Testing [4 week duration]
Recruitment of 8-10 racial/ethnically diverse YMSM, Trans, and gender non-conforming youth. Study participants will participate in one online focus group session to download and review the app, one virtual session with the live PrEP Navigator in either chat or video conference format, and a one-on-one exit interview with a research staff member about their app feedback. Participants will also be asked to fill out Pre-Test and Post-Test survey measures to assess app feedback and general usability. Members of the working groups will be invited to use PreP2Prevent over a 2-week period acting in the role of participants. Beta testing will allow for a full assessment of both the technical functionality of the mHealth platform, and will help finalize pilot test procedures. This will include engaging with the peer navigator in two "mock" navigation sessions (one text-based and one video-based).
- Patient Navigation Feasibility [6 Months]
Source: Study logs, Post-navigation satisfaction survey Description: # navigation sessions attended/missed, delivery modality (in-person, text, video); # contacts navigator made to schedule each session, # referrals made/attended. Feasibility defined as at least 50% of individuals attending on average >2 sessions over the 3-month intervention period and a mean post-navigation satisfaction survey score of 4 or higher.
- Patient Navigation Acceptability [6 Months]
Source: In-app survey Description: A brief satisfaction assessment (5 questions) will be administered at the end of each navigation session to identify challenges experienced by the participant, the most and least helpful aspects of the session, challenges using the system, satisfaction with information provided, and any additional needs the participant had that the navigator was not able to address.
- PrEP Uptake [6 Months]
Source: Ursure Description: Point-of-care rapid urine test of tenofovir as a biological marker of PrEP use
Eligibility Criteria
Criteria
Phase 1A:
Inclusion criteria:
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PrEP providers serving YMSM from healthcare and community-based organizations located in Los Angeles County or PrEP Navigators similarly employed by healthcare and community-based organizations that deliver PrEP services to YMSM.
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18 years of age
Exclusion criteria:
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Not a PrEP provider or navigator serving YMSM from healthcare and community-based organizations located in Los Angeles County
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under 18 years of age
Phase 1B and Phase 2:
Inclusion criteria:
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16-26 years old
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cisgender male, Trans, gender non-conforming, or identify differently from the gender picked for you at birth
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identify as gay, bisexual, or some other same-sex identity, and/or report having had sex with anyone with a penis during the previous 12 months
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identify as White/Caucasian, Black/African American, Latinx, Asian-Pacific Islander, Indigenous, Native American or mixed-race
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living in the Los Angeles metro area
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have daily access to an iOS/Android smartphone and/or tablet with internet access
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know their HIV status and are HIV negative at time of enrollment.
Exclusion Criteria:
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is younger than or older than 16- to 26-years
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not cisgender male, Trans, gender non-conforming, or identify differently from the gender picked for you at birth
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does not identify as gay, bisexual, or some other same-sex identity, and/or report having had sex with anyone with a penis during the previous 12 months
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does not identify as White/Caucasian, Black/African American, Latinx, Asian-Pacific Islander, Indigenous, Native American or mixed-race
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does not report living in the Los Angeles metro area
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is non-English speaking
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does not have daily access to an iOS/Android smartphone and/or tablet with internet access
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is a person living with HIV
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for Phase 2 only, participants will be excluded if they participated in the Phase 1B focus groups
Phase 3:
Inclusion criteria:
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16-26 years old
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cisgender male, Trans, gender non-conforming, or identify differently from the gender picked for you at birth
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identify as gay, bisexual, or some other same-sex identity, and/or report having had sex with anyone with a penis during the previous 12 months
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identify as White/Caucasian, Black/African American, Hispanic/Latino/Latinx, or mixed-race
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living in the Los Angeles metro area
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have daily access to an iOS/Android smartphone and/or tablet with internet access
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report having insertive and/or receptive anal sex in the previous 6 months or report a positive STI result in the previous 6 months
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not currently on PrEP and no plan to start/restart PrEP in the following 7 days
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not currently enrolled in another HIV prevention study
Exclusion criteria:
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is younger than or older than 16- to 26-years
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not cisgender male, Trans, gender non-conforming, or identify differently from the gender picked for you at birth
-
does not identify as gay, bisexual, or some other same-sex identity, and/or does not report having had sex with anyone with a penis during the previous 12 months
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does not identify as White/Caucasian, Black/African American, Hispanic/Latino/Latinx, or mixed-race
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does not report living in the Los Angeles metro area
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is non-English speaking
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is a person living with HIV (self-reported)
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does not report insertive and/or receptive anal sex in the previous 6 months or does not report a positive STI result in the previous 6 months
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does not have daily access to an iOS/Android smartphone and/or tablet with internet access
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is currently on PrEP or has plans to start/restart PrEP in the following 7 days; and
- is currently enrolled in another HIV prevention study.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Children's Hospital Los Angeles | Los Angeles | California | United States | 90027 |
Sponsors and Collaborators
- Children's Hospital Los Angeles
- University of North Carolina
Investigators
- Principal Investigator: Michele D Kipke, PhD, Children's Hospital Los Angeles
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- CHLA-20-00596