Davis-Ewart Leah, Grov Christian, Verhagen Rachel, Manuel Jennifer, Viamonte Michael, Dilworth Samantha, O'Dell Nicole, Valentin Omar, Carr Sidney, Cherenack Emily, Henderson Chelsea, Doblecki-Lewis Susanne, Nahum-Shani Inbal, Carrico Adam W
Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States.
Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States.
JMIR Res Protoc. 2023 Oct 13;12:e48459. doi: 10.2196/48459.
Although pre-exposure prophylaxis (PrEP) could substantially mitigate HIV risk, sexual minority men who use stimulants commonly experience difficulties with engaging in PrEP clinical services. Motivational interviewing (MI) and contingency management (CM) reduce substance use and condomless anal sex (CAS) in this population, but these motivational enhancement interventions require modifications to promote engagement along the PrEP care continuum.
PrEP Readiness Interventions for Supporting Motivation (PRISM) is a pilot sequential multiple assignment randomized trial testing the feasibility, acceptability, and preliminary effectiveness of distinct combinations of telehealth MI and CM in 70 cisgender sexual minority men who use stimulants that are not currently taking PrEP.
A national sample was recruited via social networking applications to complete a baseline assessment and mail-in HIV testing. Those with nonreactive HIV results were randomized to receive either (1) a 2-session MI intervention focusing on PrEP use (session 1) and concomitant stimulant use or CAS (session 2) or (2) a CM intervention with financial incentives for documented evidence of PrEP clinical evaluation by a medical provider (US $50) and filling a PrEP prescription (US $50). At the 3-month follow-up assessment, participants who reported they had not filled a prescription for PrEP were randomized a second time to either (1) switch to a second-stage intervention (ie, MI+CM or CM+MI) or (2) continue with assessments only. Outcomes for both responders and nonresponders were reassessed at a 6-month follow-up. The primary outcome is documented evidence of filling a PrEP prescription over 6 months. Self-reported secondary outcomes include PrEP clinical evaluation by a medical provider, stimulant use, and CAS. Qualitative exit interviews were conducted with a subgroup of responders and nonresponders to characterize their experiences with the MI and CM interventions.
Implementation of PRISM underscores challenges in reaching sexual minority men who use stimulants to optimize HIV prevention efforts. Approximately 1 in 10 (104/1060) eligible participants have enrolled. Of the 104 who enrolled, 87 (84%) completed mail-in HIV testing. We delivered 5 preliminary HIV-positive results, including posttest counseling with referrals to confirmatory testing.
Lessons learned from PRISM underscore the central importance of a flexible, participant-centered approach to support the engagement of sexual minority men who use stimulants. Leveraging telehealth platforms to deliver motivational enhancement interventions also expanded their reach and potential public health impact with this high-priority population. Further research is needed to determine the effectiveness of telehealth MI and CM for supporting PrEP use in sexual minority men who use stimulants.
ClinicalTrials.gov NCT04205487; https://clinicaltrials.gov/study/NCT04205487.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48459.
尽管暴露前预防（PrEP）可大幅降低感染艾滋病毒的风险，但使用兴奋剂的性少数男性在参与PrEP临床服务时通常会遇到困难。动机性访谈（MI）和应急管理（CM）可减少该人群的药物使用和无保护肛交（CAS），但这些动机增强干预措施需要进行调整，以促进在PrEP护理连续过程中的参与度。
支持动机的PrEP准备干预措施（PRISM）是一项试点序贯多重分配随机试验，旨在测试远程医疗MI和CM的不同组合在70名未服用PrEP的使用兴奋剂的顺性别性少数男性中的可行性、可接受性和初步有效性。
通过社交网络应用程序招募全国性样本，以完成基线评估和邮寄HIV检测。HIV检测结果为阴性的参与者被随机分为两组：（1）接受为期2节的MI干预，重点是PrEP使用（第1节）和同时使用兴奋剂或进行CAS（第2节）；（2）接受CM干预，为有医疗提供者记录的PrEP临床评估证据（50美元）和开具PrEP处方（50美元）提供经济激励。在3个月的随访评估中，报告未开具PrEP处方的参与者再次被随机分为两组：（1）转为第二阶段干预（即MI+CM或CM+MI）；（2）仅继续进行评估。在6个月的随访中，对反应者和无反应者的结果进行重新评估。主要结果是在6个月内开具PrEP处方的记录证据。自我报告的次要结果包括医疗提供者进行的PrEP临床评估、兴奋剂使用和CAS。对一部分反应者和无反应者进行了定性退出访谈，以描述他们在MI和CM干预中的经历。
PRISM的实施凸显了接触使用兴奋剂的性少数男性以优化艾滋病毒预防工作所面临的挑战。约十分之一（104/1060）符合条件的参与者已登记入组。在登记的104人中，87人（84%）完成了邮寄HIV检测。我们给出了5个初步的HIV阳性结果，包括检测后咨询并转介进行确认检测。
从PRISM中吸取的经验教训凸显了采用灵活、以参与者为中心的方法来支持使用兴奋剂的性少数男性参与的核心重要性。利用远程医疗平台提供动机增强干预措施也扩大了其对这一高优先级人群的覆盖范围和潜在公共卫生影响。需要进一步研究以确定远程医疗MI和CM在支持使用兴奋剂的性少数男性使用PrEP方面的有效性。
ClinicalTrials.gov NCT04205487；https://clinicaltrials.gov/study/NCT04205487。
国际注册报告识别码（IRRID）：DERR1-10.2196/48459。
