A Randomized Controlled Pilot Study of a Culturally-Tailored Counseling Intervention to Increase Uptake of HIV Pre-exposure Prophylaxis Among Young Black Men Who Have Sex with Men in Washington, DC

Abstract

Daily emtricitabine/tenofovor is effective at preventing HIV acquisition and is approved for HIV pre-exposure prophylaxis (PrEP). Blacks in the United States have a disproportionately high rate of HIV, and uptake of PrEP has been very low in this population. We conducted a pilot study in a high-prevalence city to test whether a culturally-tailored counseling center for young Black men who have sex with men (BMSM) positively impacted their access and uptake of PrEP. 50 young BMSM were randomized to either a PrEP counseling center group or a control group, and were then encouraged to obtain PrEP from a PrEP provider. At the end of 3 month study, six participants in the intervention group compared with none in the control group had initiated PrEP (p = 0.02). This pilot study demonstrates that a culturally-tailored counseling center might be an effective at increasing the uptake of PrEP in young BMSM.

Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Men Who Have Sex with Men (MSM): A Scoping Review on PrEP Service Delivery and Programming

“…This could be through existing relationships between the individuals and healthcare providers or counsellors but also through established referral systems. A clear referral route into the PrEP care pathway was highlighted in 14 studies [ 53 , 55 , 57 , 61 , 62 , 66 , 68 , 69 , 73 , 79 , 83 , 101 , 115 , 117 , 123 ]. Pathways may need to accommodate a number of referral routes, including online platforms, testing services, LGBT services, self-referrals (such as word of mouth, dating apps and online search engines), peer and community-based organisations, primary care practices or general practices, other departments (such as health, infectious disease, sexual health, urgent care or emergency), social organisations, medical agencies as well as by transitioning patients who were previously prescribed post-exposure prophylaxis (PEP) and through partners seen at HIV or sexual health clinics.…”

“…Outside of routine PrEP care, services included LGBT-friendly support, [ 67 ] social support including mental health, homelessness and substance use, [ 65 , 128 ] prevention and treatment of unrelated diseases, [ 128 ] sexual health education, [ 52 , 55 , 78 , 118 ] vaccine administration, [ 69 , 105 ] pharmaceutical patient assistance programs and outreach programs [ 67 , 78 , 88 ]. 15 studies focused on the positive impact of counselling or discussion-based services [ 52 , 54 , 62 , 65 , 66 , 72 , 73 , 79 , 87 , 88 , 91 , 92 , 96 , 108 , 129 ]. Providing these services, particularly with certain demographics such as adolescents and ethnic minorities, proved to increase adherence and uptake [ 65 , 66 , 88 , 91 , 92 , 108 ].…”

“…15 studies focused on the positive impact of counselling or discussion-based services [ 52 , 54 , 62 , 65 , 66 , 72 , 73 , 79 , 87 , 88 , 91 , 92 , 96 , 108 , 129 ]. Providing these services, particularly with certain demographics such as adolescents and ethnic minorities, proved to increase adherence and uptake [ 65 , 66 , 88 , 91 , 92 , 108 ]. Technology-based interventions were reported in five studies and they can be viewed as uniting the micro- and mesosystem levels .…”

“…Firstly, the 'Purview Paradox' was reported in a number of articles [55][56][57][58][59][60][61][62][63][64]. Some authors viewed sexual health workers as 'first adopters' in PrEP service delivery due to on-site expertise, [65] whilst others favored primary care staff as they are the first point of contact for high-risk patients [55,65,66]. Doblecki-Lewis [67] and Hoffman et al [55] offered a unified approach, urging services to consider 'task-shifting' between primary care staff and HIV specialists.…”

“…Additionally, young MSM require further investigation as they are less likely to be seeking HIV/STI testing, diagnosis or treatment for HIV [145]. While Amico et al [108], Desrosiers et al [66] and Refugio et al [130] discuss interventions and techniques to help increase the uptake of PrEP among youths, namely through technology and apps, considerably more research needs to be done. At service level, the majority of service providers described positive attitudes towards PrEP prescribing with only two studies reporting that providers did not feel comfortable with the current procedures [61,76].…”