Using Implementation Science to Enhance HIV Prevention for Young Men who have Sex with Men - PROJECT SUMMARY/ABSTRACT Background: Young men who have sex with men (YMSM) bear a disproportionate burden of HIV incidence in the U.S. Though pre-exposure prophylaxis (PrEP) use is increasing among YMSM, dropout from care is high, and YMSM are more likely than older MSM to contract HIV after discontinuing PrEP. CDC recommends motivational interviewing (MI) and personalized health education as part of PrEP care, and these evidence- based practices are promising for increasing retention in care. Providers lack sufficient time to implement them. Implementation research is needed to investigate how to facilitate their delivery in diverse clinic settings. Present Study: The proposed mentored patient-oriented career development award (K23) project will use implementation science methods to deliver and evaluate an enhanced care intervention, HIV Prevention Plus Care (HP+ Care), for YMSM starting PrEP in two clinics. HP+ Care will include MI and personalized health education to promote retention in care and use of PrEP and other prevention methods. Specific aims are: (1) using the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, investigate factors influencing implementation of HP+ care for YMSM in the constructs of the recipients (staff), their context (clinics), and the innovation (MI and personalized health education); (2) using Aim 1 data, identify appropriate Expert Recommendations in Implementing Change (ERIC) implementation strategies to facilitate delivery of HP+ Care in two clinics; and (3) conduct a trial of HP+ Care in two clinics to assess feasibility, acceptability, and appropriateness. Candidate: Andrew Barnett, Ph.D., is a clinical psychology postdoctoral fellow at the Alpert Medical School of Brown University whose research focuses on addressing health disparities, including HIV, among sexual and gender minority adolescents and young adults. Mentoring: The primary mentor, Dr. Larry Brown, is an expert in implementing evidence-based practices to prevent HIV and enhance HIV care, and three co-mentors have complementary expertise in rigorous quantitative analysis methods (Dr. Barker); HIV prevention and PrEP engagement in clinic settings (Dr. Chan); and applying implementation science methods to improve delivery of evidence-based practices in healthcare (Dr. Elwy). The mentors also each have extensive experience guiding early career researchers. Training: Training activities will advance the following goals: (1) gain experience in conducting implementation science investigations to prevent HIV in healthcare settings; (2) expand knowledge of novel biomedical HIV prevention approaches, including PrEP on-demand, long-acting injectable PrEP, and other modalities currently under development; (3) gain expertise in methods for quantitative analysis of clustered data, including hierarchical linear modeling; and (4) advance professional development, research ethics, and grants management skills. Training will prepare the candidate to conduct NIH-funded independent investigations.
