Abstract
Malaysia's HIV epidemic is rapidly expanding with recent evidence suggesting accelerated sexual
transmission, especially among men who have sex with men (MSM): 10% in 2008 to 54% in 2016. Biobehavioral
surveys suggest high HIV prevalence in MSM being nationally (21.6%) and in Kuala Lumpur (43%). Substance
use, especially amphetamine-type stimulants (ATS), increases condomless sex and STIs in MSM, and promotes
HIV transmission. In Malaysia where both homosexuality and drug use are criminalized, substance-using MSM
dually bear the burden of social stigma and discrimination. Consequently, they are marginalized from traditional,
venue-based HIV prevention services, which undermines recommendations by international agencies. To
address stigma and discrimination, mHealth (mobile technology to promote health) strategies can deliver
prevention messages and guide health decisions anonymously, and thus hold great promise for MSM, especially
those using ATS. They can overcome barriers along the HIV prevention cascade that now includes pre-exposure
prophylaxis (PrEP). Combined with strong training and mentoring, the proposed projects directly address this
need through the conduct of two formative studies. First, information about MSM's preferences of various
attributes of PrEP delivery programs, including segmentation of ATS-using MSM, will be assessed. Then,
building on the first study, the candidate will develop and test an mHealth-based intervention to overcome
barriers along the prevention continuum, including HIV testing, co-occurring sexual and drug risk behaviors and
PrEP uptake among Malaysian MSM. Findings from these related projects will provide the candidate with the
necessary skills and competencies to develop and test an innovative and tailored primary HIV prevention
intervention for MSM. This K01 application for Dr. Shrestha is well-suited to advance the career of the candidate
by virtue of his training in intervention design, delivery, and placement, his high productivity in public health
research, and his evolving experience with research in the Malaysian context. Over 5 years, he will achieve new
skills and experiences to achieve his professional goals and objectives to: 1) gain experience in decision science
with advanced quantitative and qualitative skills to become an independent investigator in HIV, substance use,
and mHealth intervention for vulnerable populations; 2) develop expertise in mHealth intervention
development, testing, implementation, and dissemination that will address specific barriers to HIV prevention
services in MSM, especially those with substance use disorders; and 3) develop an independent career path
focusing on HIV prevention using mHealth strategies among substance-using MSM. To achieve these goals, he
has assembled a stellar interdisciplinary team of mentors with expertise in HIV, substance use, intervention
design, decision science, and mHealth research. Under their guidance, he will complete relevant didactic work
and attend seminars and conduct research to apply the skills needed to become an independent researcher in
mHealth-based HIV prevention among substance-using MSM.