Male Access to Sexual Health Services and PrEP - Despite advances in HIV prevention, men remain less likely to engage in HIV testing, prevention, and sustained care, including in the United States and South Africa. Men in the U.S. and South Africa have sub-optimal HIV prevention engagement, Pre-Exposure Prophylaxis (PrEP) persistence, and retention in care, demonstrating a need for scalable implementation strategies for those underserved by conventional healthcare systems. South Africa provides both a high HIV prevalence setting and established research infrastructure to evaluate scalable behavioral and implementation science relevant to HIV prevention interventions globally and in the United States. The combination of the epidemiological setting, the high participant volume, and the implementation infrastructure are not readily available in the U.S., which makes South Africa an ideal environment for generating evidence for improving HIV prevention uptake among high risk and under-served men globally, and in the U.S. specifically. The scientific goal of this K43 is to develop and prototype an evidence-based intervention to improve PrEP uptake and individual factors influence health behavior. Behavioral Economics will be used to understand these factors associated with PrEP uptake and persistence in South African men. Candidate: I am a South African behavioral scientist investigating HIV prevention engagement among men in high-burden and underserved settings using scalable behavioral and implementation interventions to improve PrEP uptake and persistence. Training: The K43 will support mentoring and rigorous training expertise in 1) behavioral intervention design, 2) cohort design and managing clinical trials, 3) mixed methods research design and analysis aimed at scalable HIV prevention delivery models. These aims will be supported by mentors in HIV prevention in limited resource communities: Dr. Alison Buttenheim (U.S. based, behavioral economics intervention design), Dr. Linda-Gail Bekker (S.A.-based, clinical trials, PrEP research in key populations), Dr. Joseph Daniels (U.S.-based, qualitative research), Dr. Andrew Medina-Marino (S.A. -based, men’s health, implementation science). Research: Understanding barriers to prevention uptake and sustained PrEP use among men has relevance for HIV prevention efforts globally, including in U.S. populations with low PrEP persistence and sub-optimal engagement with conventional healthcare systems. The specific research aims of this award are to: 1) investigate the influence of contextual factors on PrEP uptake, 2) describe factors associated with attrition and sustained PrEP use 3) to use BE to develop and prototype an intervention to support PrEP uptake among men. This research is nested in the existing mobile clinic services operating in the Klipfontein district in Cape Town. The evidence will be used to design a behavioral economics informed intervention designed to improve PrEP uptake, retention, and adherence among populations with low health engagement. The resulting implementation and behavioral messaging strategies will generate scalable, evidence-based tools to strengthen HIV prevention and PrEP delivery among underserved men in both high burden global settings and in the U.S. By improving uptake and sustained use among populations with low engagement, this research will contribute effective HIV prevention approaches aimed at reducing HIV acquisition, strengthening the impact of U.S. NIH supported HIV programs globally and domestically.
