ABSTRACT
Increasing access to and uptake of biomedical prevention (PEP/PrEP) is critical to ending the epidemic in the
United States (US) among gay, bisexual and other men who have sex with other men (MSM). This is particularly
true for urban, African-American or Black MSM, who are disproportionately affected by HIV and would thus
benefit from more HIV testing, which is now recommended every 3-6 months for key groups and is the gateway
to treatment and prevention. NYC is the metropolitan area in the US with the largest number of newly diagnosed
HIV infections among MSM and 89-94% of all people living with HIV/AIDS (PLWHA) in the US reside in urban
areas. Although such urban areas often have robust testing and PEP/PrEP dissemination programs, consistent
testing and PEP/PrEP uptake is unacceptably low among urban-dwelling Black MSM. There is thus a need for
interventions to support both HIV testing and PEP/PrEP uptake by accelerating existing implementation and
dissemination efforts. Most HIV testing and PEP/PrEP uptake interventions focus on individual-level navigation
of system/structural barriers and/or cognitive antecedents (intentions, motivation, skills) to behavior; few focus
on reducing stigma/discrimination-related barriers to testing/PEP/PrEP via self-testing, empowerment, peer
support and community norms. To fill this gap, we propose to test an intervention composed of evidence-based
and novel intervention components, designed by our study team, that operate at multiple levels and can be
integrated into CBO-delivered HIV prevention programming to support HIV testing and PEP/PrEP uptake. We
will estimate additive and interactive effects of the components, that include a single-session, peer-based HIV
self-testing component, a three-session PEP/PrEP navigation enhancement component, and a social and print
anti-intersectional stigma media campaign, using factorial and quasi-experimental designs. The primary
outcomes are HIV testing (while not on PrEP/PEP) and PrEP uptake. Secondary outcomes include consistent
HIV testing (2+ tests at least 3 months apart in 9 months); PEP uptake; PrEP/PEP adherence (self-report/medical
record/urine test). To achieve the study aims, we will enroll 480 PrEP-eligible Black MSM (aged 18-55) living in
Central Brooklyn into the study and randomize them to one of four study arms and follow them over 18 months.
Our study, which represents a collaboration between a community-based organization currently engaged in
PEP/PrEP uptake programming and an academic research team, is designed to identify the added value of
components that operate at different levels and are designed to increase individual-level HIV testing and
biomedical HIV prevention use among a group highly vulnerable to HIV.
