Background
Black Americans, particularly young, Black, sexual minority men in the Southern United States, experience disproportionately high HIV rates and are less likely to receive state-of-the-art interventions such as PrEP.
- The disparity in HIV burden is described as 'more profound in the Southern United States'
- Young, Black, sexual minority men are identified as having 'the highest rates' of HIV in the region
- This population is 'less likely to receive state-of-the-art interventions such as pre-exposure prophylaxis (PrEP)'
- Individual-level interventions are noted to often fail to leverage the significant effects of social networks on HIV prevention attitudes and behaviors
Background
The PrEP US NoW intervention was designed to engage young, Black, sexual minority men's social networks through Black female facilitators to enhance social capital and increase PrEP uptake.
- Intervention capitalizes on the influence of Black women in the social networks of young, Black, sexual minority men
- The approach involves 'supportive Black female facilitators' leading group discussions
- The intervention is built on enhancing 'social capital bonds' identified through qualitative research with young, Black, sexual minority men and Black women
- An existing, evidence-based mobile health app was adapted to create the PrEP US NoW platform
Methods
The intervention development phase (Phase 1) involved qualitative data collection to identify core health-promoting elements of social capital, which was used to adapt an existing mHealth app.
- Phase 1 research activities lasted from November 2019 to June 2024
- Qualitative information was captured from young, Black, sexual minority men and Black women in existing social support networks
- The information was applied to adapt 'an existing, evidence-based mobile health app'
- This qualitative foundation informed the tailoring of the intervention content
Methods
The pilot randomized controlled trial (Phase 2) uses a network-based recruitment approach with social network groups comprising five young, Black, sexual minority men and one Black woman each.
- Six social network groups are planned for the intervention arm, each consisting of '5 young, Black, sexual minority men + 1 Black woman'
- Participants will be recruited through a 'network-based approach'
- The trial is unblinded
- Data collection began in August 2024 and is expected to be completed in December 2025
- ClinicalTrials.gov identifier: NCT07024745
Methods
The intervention arm involves four 60-minute group discussions led by Black women through the modified mHealth app, supplemented by both mobile-based and face-to-face training.
- Groups engage in 'four 60-minute discussions led by Black women through the modified mobile health app'
- Participants undergo 'tailored training (mobile-based and face-to-face) for app usage'
- Participants in the control arm use a control version of the app without Black women-facilitated group discussions
- Both arms have identical baseline and follow-up survey and HIV testing procedures
Methods
Young, Black, sexual minority men in both arms undergo HIV testing and complete surveys at baseline, 1 month, and 3 months, measuring PrEP uptake, discrimination experiences, and PrEP stigma.
- HIV testing is conducted at baseline, 1 month, and 3 months for young, Black, sexual minority men
- Follow-up surveys measure 'experiences of discrimination and PrEP stigma' among other factors
- Surveys are completed electronically at 1 and 3 months post-intervention
- A sociodemographic survey is completed by both men and women at baseline
Methods
Black women facilitators complete a feasibility and acceptability survey at 1 month and participate in web-based qualitative interviews at 3 months to assess the facilitation process.
- Black women complete 'an electronic survey at 1 month, measuring feasibility and acceptability'
- Web-based qualitative interviews with Black women are conducted at 3 months
- These qualitative interviews aim to 'gain more knowledge on the PrEP US NoW facilitation process'
- Feasibility and acceptability are listed as primary pilot outcomes alongside changes in PrEP uptake
Conclusions
The PrEP US NoW intervention is hypothesized to leverage social capital among young, Black, sexual minority men to promote PrEP care engagement and decrease HIV diagnoses.
- The intervention is 'thought to leverage essential social capital among young, Black, sexual minority men'
- Anticipated outcome is that enhanced social capital 'may promote engagement in PrEP care'
- The ultimate goal is 'decreasing the overall number of HIV diagnoses'
- Findings will capture 'the intervention's feasibility and acceptability and changes in PrEP uptake'