Intervention to Enhance PrEP Uptake and Adherence in a Community-Based Setting (SPARK)

• PrEP Uptake [ Time Frame: BL through 3-months ] [ Designated as safety issue: No ]
  Whether or not the patient decides to take PrEP
  
  
• PrEP Persistence [ Time Frame: BL through 12-months ] [ Designated as safety issue: No ]
  Whether or not patients who decide to take PrEP persist with the medication for the duration of the study.
  
  
• PrEP Adherence [ Time Frame: BL through 12 months ] [ Designated as safety issue: No ]
  Biological measure of medication adherence using dried blood spots, and self-report measure of adherence using VAS.
  
  
• Sexual Risk Behavior [ Time Frame: BL through 12-months ] [ Designated as safety issue: No ]
  Measured through STI testing and self-report.
  
  

Pre-exposure prophylaxis (PrEP) refers to daily or intermittent oral administration of antiretroviral drugs designed to protect high-risk HIV-negative individuals from infection. In order for PrEP to become an effective prevention tool, three critical factors must be addressed: a) acceptability, i.e., individuals who would benefit from PrEP must know about it and be willing to take it; b) adherence, i.e., individuals who choose to PrEP as a prevention strategy must take the pills as prescribed; and c) implementation, i.e., processes and protocols must be developed to allow for the integration of PrEP delivery and programs into real world settings in a way that is feasible, scalable, and realistic. This project has three specific aims: 1) Identifying social and behavioral factors that are likely to influence PrEP implementation, acceptance, and use/adherence by men who have sex with men (MSM) in NYC, including factors at individual-, community-, and organizational-levels; 2) Examining social and behavioral factors associated with disparities in access to prevention and care services among MSM in NYC that might directly impact PrEP implementation programs and policies; and 3) Evaluating an intervention in which PrEP is introduced, provided, and supported as part of a prevention package delivered in an community health center. The project has the potential to exert a sustained and powerful influence not only on the effectiveness of PrEP interventions for MSM, but also on dissemination and scalability of a targeted intervention within community-based settings and in a manner that reduces disparities in access and maximizes cultural competence and acceptability.