Men who have sex with men (MSM) are disproportionally affected by HIV and substance abuse in the U.S.,
Europe, and Latin America. However, as in the general population, identifying and engaging MSM with
problematic substance use (PSU) into treatment is a significant challenge, which results in the great majority of
MSM with PSU never receiving treatment. The Substance Abuse and Mental Health Services Administration
(SAMHSA) recommends Screening (S), Brief Intervention (BI), and Referral to Treatment (RT; SBIRT) as an
early intervention for non-treatment-seeking individuals with risky alcohol and drug use, as well as the timely
referral to more intensive substance abuse treatment for those with substance use disorders. The need for such
an intervention is particularly acute in Argentina and Latin America, where there is little implementation of
evidence-based interventions for MSM with PSU. The proposed study seeks to address this glaring gap by
developing and piloting an electronic-SBI program tailored for MSM awaiting their HIV test at Nexo Asociacion
Civil, our community partners in Buenos Aires. The tablet-based e-SBI will integrate substance use and sexual
risk behavior screeners and individually tailored Motivational Interviewing (MI) as the BI. We will also adapt and
pilot the implementation of the Young Men’s Health Project (YMHP, now MHP since it will not be limited to young
MSM), a four-session MI-based intervention that effectively reduced substance use and condomless anal
intercourse among substance using MSM, as a brief treatment provided at Nexo for participants with moderate
or high-risk substance use. The Specific Aims of this R34 study are to: 1) develop a tailored e-SBI intervention
for MSM in an HIV testing context aimed at reducing substance use and HIV risk behavior (Primary); 2) assess
the feasibility and acceptability of integrating e-SBI into the HIV testing process at Nexo as measured by a)
percent of MSM testing clients at Nexo who accept entry into the study; b) percent of participants who complete
e-SBI; c) e-SBI acceptability ratings (Primary); 3) assess the feasibility and acceptability of implementing adapted
YMHP at Nexo, as measured by a) the percent of MSM with moderate or high-risk substance use who enter
and/or complete MHP; b) acceptability of MHP among those who received it; and c) percentage of sessions
conducted by each MHP counselor that meets criteria for MI fidelity (Secondary). In Stage 1 (Development) we
will develop e-SBI, adapt YMHP into MHP, train MHP counselors, and pilot e-SBI with 50 MSM coming to Nexo
for HIV testing. In Stage 2 (RCT Pilot), we will randomize 200 MSM coming to Nexo for HIV testing at a 3:1 ratio
(eSBI: Screening Assessments Only-SA) to assess the feasibility and acceptability of e-SBI among MSM coming
to Nexo for HIV testing and establish and pilot the RCT process for a future trial. As a secondary aim, we will
assess uptake, acceptability, and feasibility of delivering MHP to participants with low or moderate risk substance
use and subsequent referrals to substance abuse treatment among participants with high-risk substance use or
dependence. Lastly, we will explore preliminary findings on substance use and sexual risk reduction outcomes.
