Feasibility of Short-Term PrEP Uptake for MSM with Episodic High-Risk for HIV

Primary Investigator

Ron Stall

Project Funder

This project is supported by an R01 from the National Institute of Mental Health.

Project Description

This proposed study is designed to investigate the acceptability, perceived need and uptake of episodic HIV Pre-Exposure Prophylaxis (PrEP) among men who have sex with men (MSM) who have limited risk periods. Chronic PrEP use may be unnecessary for most HIV-negative men who do not have sustained periods of high-risk sex, but may have episodic, contextually defined, high-risk periods, particularly when away from home. Alternative dosing strategies, such as short-term fixed-interval episodic PrEP (Epi-PrEP), may be a more feasible, acceptable and cost-effective option with high public health impact for the majority of high-risk MSM whose risk behaviors may be best described as episodic and non-random.

PrEP has the potential to dramatically raise the effectiveness of current HIV prevention efforts if it is correctly used. However, many questions remain about the most effective methods to promote the appropriate uptake of PrEP for the many MSM who only experience episodic periods of risk. Until we can find ways to circumvent barriers of self-identification (i.e. episodic users may not identify as “high risk”), willingness to use PrEP will be limited, impeding the promise of PrEP to prevent new HIV infections among MSM.. This proposal is designed to investigate several questions essential to the development of efficacious Epi-PrEP uptake and adherence programs. Success of this strategy, implementing short-term, fixed interval PrEP will depend on the ability of high-risk MSM to predict periods of contextually driven heightened risk, and to be adherent to Epi-PrEP regimens during these time-limited high-risk periods. In order to develop an optimized Epi-PrEP package, several questions must be addressed. This study aims to understand the prevalence and patterns of episodic risk among MSM< and to investigate how best to help MSM request and utilize Epi-PrEP during high-risk phases of their lives. The specific aims of this proposal are therefore to:

This proposes a set of research activities necessary to understanding methods to help high-risk MSM access PrEP for time-limited, context-specific situations of heightened risk. believe this is first study to propose the rigorous assessment of an episodic PrEP intervention for MSM. Findings from this study will provide the empirical platform necessary to supporting the design, implementation and evaluation of the effectiveness of a short-term fixed interval episodic PrEP adherence intervention. If successful, this research agenda will provide an improved HIV prevention tool for substantial numbers of “high-risk” MSM whose risky periods are time limited, who do not need chronic PrEP.

 

Co-Investigator: James E Egan