Interventions to Improve the HIV PrEP Cascade Among Methamphetamine Users

Not Applicable

Completed

Brief Summary: Despite increasing knowledge about and use of PrEP nationally, HIV continues to have disproportionate impact among cisgender men and transgender persons who have sex with men and transgender persons (MSM/TG), with methamphetamine (meth)-users being at particularly high risk. Building on their preliminary work, the investigators will pilot text messaging and peer navigation interventions to support PrEP use among meth-using MSM/TG with potential to be cost-effective, scalable, and easily adaptable.

Detailed Description: Despite increasing knowledge about and use of PrEP nationally, HIV continues to have disproportionate impact among cisgender men and transgender persons who have sex with men and transgender persons (MSM/TG), with methamphetamine (meth)-users being at particularly high risk. Despite apparent high levels of PrEP knowledge and exceptional insurance and medication coverage, few meth-users in Western WA have enrolled in local PrEP programs. The investigators' preliminary work with meth-using MSM/TG has identified both traditional barriers to PrEP and barriers specific for meth users, including competing priorities (e.g., getting high); lack of regularity in daily schedules leading to difficulties complying with appointments and medication adherence; and concomitant wellness and social concerns, notably depression and meth-related stigma. Additional work is needed to develop new strategies to increase PrEP uptake and support persistence and adherence among meth-using MSM/TG. Building on their preliminary work, the investigators will pilot text messaging and peer navigation interventions to support PrEP use among meth-using MSM/TG with potential to be cost-effective, scalable, and easily adaptable. The first, peer navigation, has been studied in ARV treatment and has been proposed for PrEP. The second, text messaging, has been shown to increase ARV and PrEP adherence.

Recruitment & Eligibility

Inclusion Criteria

Meets the clinic's eligibility criteria for PrEP
18 years of age or older
HIV-negative
Cisgender man or individual on the trans gender variant spectrum who has sex with men
Ability to understand, read, and speak English
Reports meth use in the past 3 months
Has a cell phone able to send and receive text messages

Exclusion Criteria

PrEP use in the prior month,
Discomfort or anxiety with regards to text messaging.
Has any circumstances that, based on the study staff's opinion, would preclude provision of informed consent, make participation unsafe, or make it unlikely the participant would be able to participate for 6 months.

Arm && Interventions

Group	Intervention	Description
Peer Navigation	Peer Navigation	Participants in this group will receive the peer navigator intervention.
Text Messaging and Peer Navigation	Text Messaging	Participants in this group will receive both the text messaging and peer navigation interventions.
Text Messaging	Text Messaging	Participants in this group will receive the text messaging intervention.
Text Messaging and Peer Navigation	Peer Navigation	Participants in this group will receive both the text messaging and peer navigation interventions.

Primary Outcome Measures

Name	Time	Method
Acceptability of Text Messaging	6 months	Self-reported likelihood to recommend the text messaging intervention, via survey response, among those who received the text messaging intervention (may have been in the Standard of care group or the Peer Navigation group). Only participants who received the text messaging intervention are included in the analysis group.
Acceptability of Peer Navigation	6 months	Self-reported likelihood to recommend the peer navigation intervention, via survey response, among those who were assigned to the peer navigation group. Only participants who received the peer navigation intervention are included in the analysis group.

Secondary Outcome Measures

Name	Time	Method
PrEP Persistence	6 months	Persistence on PrEP comparing standard of care or text messaging vs peer navigation, as measured by whether the participant had returned to the clinic at 6 months follow up their DBS card collection.
PrEP Adherence	6 months	PrEP adherence measured in dried blood spots comparing standard of care/text messaging vs peer navigation, as measured by the detection of tenofovir-diphosphate (TFV-DP) in DBS collected 6 months after study enrollment.