Mobile Technology and Incentives (Motives) for Racial and Ethnic Minorities in Los Angeles

Abstract:  HIV disproportionately affects sexual and gender minorities such as men who have sex with men (MSM) and transgender women (TGW). These individuals do not always receive the most up-to-date information on rapidly evolving guidelines in a time of new prevention technologies such as pre-exposure prophylaxis, leading to confusion in the face of recent HIV prevention developments. A lack of engagement in the traditional health care system also leads to infrequent testing for HIV. Novel ways are urgently needed to supply MSM and TGW with the most recent and accurate HIV prevention information to promote HIV health literacy and highlight the pitfalls of indirect assessments of potential infectivity rather than trimestral testing as recommended by the CDC. Mobile technologies such as text messaging present a dynamic new way to improve access to critical prevention information and care for MSM and TGW, but better ways of adapting them to the unique needs of MSM and TGW are needed, and creative ways of keeping them engaged are critical. Given the growing recognition that even if people have all necessary information and are motivated, they commonly fail to show healthy behavior, this proposal employs novel insights from behavioral economics to provide frequent feedback and incentives to keep participants engaged and support them in their intention to remain HIV negative. This proposal entails a 3-phase mobile technology based and BE supported HIV prevention intervention – called Mobile Technology and Incentives (MOTIVES) – to increase engagement with HIV prevention information and improve testing frequency. Formative Phase 1 includes 30 semi-structured interviews with MSM and TGW to finalize the planned intervention based on the insights from a preliminary study. Phase 2 will enroll 200 HIV- negative MSM and TGW in an 18-month, two-arm randomized controlled trial (RCT). Those in the intervention group will receive weekly text messages with HIV prevention information, and can win reward points for correctly answering weekly quizzes to keep them engaged and improve their retention of the HIV prevention information. Those who continue to test negative for HIV at least once every three months can enter a prize drawing to win prizes, with larger chances for those correctly answering the weekly quizzes. The control group will receive the same HIV prevention information but without the incentives. The primary outcomes include frequency of HIV testing and HIV prevention knowledge. Phase 3 includes 7 exit focus groups (with 5-8 participants per group) to evaluate areas for study improvement and estimate parameters for future scale up. The Specific Aims are to 1) develop MOTIVES and finalize the weekly text message information content and the types of incentives; 2) implement and evaluate the impact of MOTIVES; and 3) evaluate areas of improvement for MOTIVES through focus groups and estimate mission-critical design parameters with point and confidence interval estimates for a subsequent, fully-powered R01 application.

 

 

Project Number: 5R34MH109373-02

https://reporter.nih.gov/search/RSa1tMjoTkCcAib3ShEi7w/project-details/9305148

 

 

Contact PI/ Project Leader

LINNEMAYR, SEBASTIAN, ECONOMIST (slinnema@rand.org)

 

Organization

RAND CORPORATION

 

PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE For public health it is important to improve the access of populations at high risk for HIV to the most up-to-date HIV prevention information and encourage them to test for HIV at appropriate intervals. Our study will make use of HIV testing sites as an entry point to enroll study participants and send them HIV prevention information tailored to address the specific needs of men who have sex with men and transgender women along with reminders to get tested for HIV at least once every three months by mobile phone, complemented by incentives to stay engaged in the study. The insights from this R34 grant will serve as the basis for a subsequent grant application to implement such an intervention at scale.

 

 

 

 

Project Start Date: 01-July-2016

Project End Date: 30-June-2019

Budget Start Date: 01-July-2017

Budget End Date: 30-June-2018

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE OF MENTAL HEALTH / FY Total Cost by IC: $257,938

A Comprehensive Community-Based Strategy to Optimize the HIV Prevention and Treatment Continuum for Youth at HIV Risk, Acutely Infected and With Established HIV Infection

Abstract: America’s increasing HIV epidemic among youth aged 12-24 and our concurrent failure to identify, link to care, and achieve viral suppression among youth living with HIV (YLH) suggests the need to identify novel community-based strategies to leverage gateways and settings where high risk and infected youth can be engaged in HIV prevention and treatment. Scientific successes reducing HIV viral reservoirs among acutely infected infants, stopping HIV transmission from HIV-infected adults with undetectable viral loads, and documenting the efficacy of Treatment as Prevention (TASP) suggest strategies to reduce the trend of increasing adolescent HIV infections. This U19 will evaluate the usefulness of these advances for youth aged 12-24 at the highest risk of acquiring HIV- gay, bisexual, transgender youth (GBTY) and homeless youth (HY) – as well as youth living with HIV (YLH) in two HIV epicenters (Los Angeles and New Orleans). All GBTY and HY at five gay-identified community-based organizations (CBO) and homeless shelters will be screened over 18 months. From these screenings, a cohort of 220 YLH and 1,500 highest risk seronegative GBTY and HY will be formed. Over 24 months, this cohort will be repeatedly tested at four month intervals for sexually transmitted infections (STI) and serious drug use, and with 4th Gen HIV tests if seronegative, in order to identify acutely infected youth, engage youth in medical care, and monitor outcomes. Youth are triaged to: Study 1: Acute infection. Using 60 ARV-naive YLH with established infection as controls, we expect to identify 36 YLH with acute infection. All youth with acute infections will be aggressively treated with at least four highly potent antiretroviral therapies (ARV) and repeatedly assessed to examine if prolonged viral suppression is achieved, with reduced viral reservoirs to potentially allow ARV- free HIV remission. Study 2: Stepped care for YLH. Adapting strategies to manage chronic illnesses, we will conduct a RCT comparing a Standard Care Arm (repeated assessments every four month and an Automated Messaging and Monitoring Intervention [AMMI]) to Stepped Care. In the Stepped Care Arm, increasingly more intense interventions are delivered if viral load is detectable: a) the Standard Care Arm; b) an AMMI that is tailored to comorbidities of the specific YLH; or c) a Coach to support during crises, make treatment referrals, and brief interventions. Dried blood spots will monitor viral load and, on a small sample, ARV adherence over time. Study 3: Engaging seronegative youth in the HIV Prevention Continuum. Youth will be randomized to either: a) an AMMI Arm; b) Peer-Support plus AMMI Arm; c) eNavigator and an AMMI arm; or d) Peer-Support plus eNavigator plus AMMI Arm. Each condition aims to optimize the HIV Prevention Continuum. An interdisciplinary team of basic, clinical, and applied researchers with expertise in HIV, STI, behavioral interventions, biomedical interventions, CURE research, perinatal HIV, and a history of participating and coordinating multi-site RCT is participating on this U19 from six universities.

 

Project Number: 5U19HD089886-02

https://reporter.nih.gov/search/HbqgtLEtKUG1ysdAGWkuMQ/project-details/9353195

 

 

Contact PI/ Project Leader

ROTHERAM-BORUS, MARY JANE, PROFESSOR (ROTHERAM@UCLA.EDU)

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE: Project Narrative HIV among youth has doubled in the last 15 years, with incidence expected to increase 39% by 2020. If acutely infected youth can be identified and treated during the period when their infectivity to others is 5-to 10-fold, we can reduce this expected rise as well as improve youth’s long-term health, reflected in smaller viral reservoirs. The set of studies in this U19 tests a comprehensive set of strategies for acutely infected youth, youth with established infection, and seronegative youth at highest risk of acquiring and transmitting HIV –with policy implications for communities and the Centers for Disease Control and Prevention.

 

 

FOA:  RFA-HD-16-035Study Section: ZHD1-DSR-N(50)1

 

Project Start Date:30-September-2016

Project End Date: 31-May-2021

Budget Start Date: 01-June-2017

Budget End Date: 31-May-2018

 

 

NIH Categorical Spending

Funding IC: EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT/ FY Total Cost by IC: $3,738,607

SNS-Based Data Mining to Understand MSM Substance Use and HIV Risk Behavior

Abstract: HIV incidence among gay, bisexual and other men who have sex with men (hereafter MSM) continues to rise, driven in part by substance use. MSM are increasingly using social networking sites (SNS) to find substance use and sexual partners. However, no studies currently exist that use automated, real-time data collection and analysis procedures to monitor substance use and sexual partner seeking across the range of SNS platforms used by MSM to inform intervention development. This project will build on Routine Activities Theory to conduct research using SNS interactions to aid in understanding patterns of substance use and HIV risk behavior among MSM. During Phase 1, focus groups of MSM (n=~8/focus group; N=24) will be used to develop a lexicon for identifying substance use and sexual partner seeking among MSM via diverse SNS platforms. These findings will guide the development of a culturally congruent data collection and mining module (DCMM; internet software that systematically searches SNS to gather data in an analyzable format) with iterative feedback from a community advisory board (CAB) and pilot testing by MSM (n=6). During Phase 2, the DCMM will gather data from 50 MSM on SNS use (e.g., frequency, intensity) substance use and HIV risk/protective behaviors (e.g., content of profiles, postings). Risk behaviors will be assessed weekly via self- report and validated with biomarkers of risk behaviors to be collected at the end of the study period using a rapid oral HIV test and drug test via nail sample. This research will result in a subsequent R34 application to develop and test a just-in-time adaptive intervention (JTAI) using machine learning technology. The specific aims of the proposed research are to: (1) Develop and assess the utility of a culturally congruent DCMM to study the SNS use patterns, substance use and HIV risk and protective behaviors of MSM; (2) Determine associations between patterns of technology use, substance use and HIV risk behaviors among a sample of 50 MSM using a culturally congruent DCMM, self-report data collection and biomarkers for substance use and HIV; and (3) Evaluate the feasibility and the computational requirements of a just-in-time adaptive intervention to reduce substance use and HIV risk behavior among MSM. By devising and testing a culturally congruent DCMM to capture SNS data on MSM substance use and sexual partner seeking this study lays the building blocks to developing technology-based substance use and HIV prevention and treatment efforts tailored specifically for MSM.

 

Project Number: 5R03DA039752-02

https://reporter.nih.gov/search/UC7JBjMVIUuHREV5b0mu3A/project-details/9303328

 

 

Contact PI/ Project Leader

HOLLOWAY, IAN WALTER, ASSOCIATE PROFESSOR (holloway@luskin.ucla.edu)

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE: Gay, bisexual and other men who have sex with men (hereafter MSM) use social networking sites (SNS) to locate substance use and sexual partners, which can increase their risk for HIV acquisition and transmission. This study will devise and test a culturally congruent data collection and mining module (DCMM) to capture large quantities of SNS data on MSM substance use and sexual partner seeking. This formative research has high public health significance as it can clarify the SNS partner seeking dynamics driving MSM’s substance use and sexual risk behaviors to inform culturally congruent technology-based substance use and HIV prevention and treatment efforts tailored specifically for MSM.

 

 

 

Project Start Date: 01-July-2016

Project End Date: 30-June-2020

Budget Start Date: 01-July-2017

Budget End Date: 30-June-2020

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE / FY Total Cost by IC: $154,000

UCLA Thai MOPH Epidemiology Training Program on AIDS

Abstract: Although the prevalence of HIV in Thailand has been declining recently among the general population, the level remains high among drug users (20%+), MSM (8-22%) and sex workers (7% among direct sex workers and 21% among street walkers). A high proportion of infected individuals in need of treatment (currently set at 350 mm3 CD4 cells) still do not receive treatment, and a high proportion of newly identified individuals already have low CD4 levels. The Thai Ministry of Public Health is now implementing a new strategy, the Area-Based Surveillance System, which will require expanding their research capacity and to generating more accurate strategic information. Through a series of in-country courses and short- and long- term training in advanced research methodologies, the UCLA Department of Epidemiology proposes to assist the Division of Epidemiology of the Thai Ministry of Public Health to achieve the goals of the Area-Based Surveillance System to enhance research capacity. Thus, we propose to train four M.S. candidates, two Ph.D. candidates, and three short-term postdoctoral trainees at UCLA. The degree candidates will conduct their field research for their theses and dissertations in Thailand under the supervision of the Thai faculty members. The short courses to be given in Thailand include strategies for communicating public health messages, strategies for implementing community intervention programs, modeling for disease burden, assessment of intervention strategies, mobile phone and internet technologies for data collection, program monitoring, coordination and supervision of staff, and evidence-based behavioral interventions. Candidates for the UCLA-based programs will be recommended by the Thai faculty on the basis of their academic records, commitment to HIV and public health research, and intention to promote the health of Thais (all of our previous trainees have returned to Thailand).

 

Project Number: 5D43TW009583-04

https://reporter.nih.gov/search/TRxKtc-A1UybLNjtWuRH3w/project-details/9266511

 

 

Contact PI/ Project Leader

DETELS, ROGER, PROFESSOR (DETELS@UCLA.EDU)

LEE, SUNG-JAE

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE: Thailand has experienced one of the most severe HIV epidemics in Southeast Asia. The Division of Epidemiology of the Thai Ministry of Public Health and the have taken the lead in developing surveillance programs and conducting research essential for developing and evaluating sound HIV/AIDS policy. The proposed UCLA/Fogarty Thai Ministry of Public Health program in advanced research methodology will assist the Ministry of Public Health by training public health professionals to conduct relevant HIV/AIDS research and to develop and assess evidence-based intervention strategies for control of HIV in Thailand.

 

 

 

Project Start Date: 27-May-2014

Project End Date: 31-March-2019

Budget Start Date: 01-April-2017

Budget End Date: 31-March-2018

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE ON DRUG ABUSE + FOGARTY INTERNATIONAL CENTER / FY Total Cost by IC: $160,000

Natural History of AIDS in Homosexual Men

Abstract: The UCLA Center of the Multicenter AIDS Cohort Study proposes to continue to document clinical, immunologic, physiologic, behavioral, virologic, genetic and psychosocial changes in HIV-infected and -uninfected men-who-have-sex-with-men (MSM). This includes proposed studies to document these changes in MSM recruited 1983-4 and 2001-2, as well as plans to recruit new untreated and recently treated HIV-infected MSM (primarily African- and Hispanic- Americans), to maintain the cohort. The UCLA MACS will provide leadership and participation in the working groups, MACS-wide and local studies and research publications, and collaborative multi-cohort studies, as it has since the inception of the MACS 30 years ago. The UCLA MACS has recruited a large team of young and established co-investigators from a wide range of disciplines. These investigators have developed, and are continuing to develop, innovative proposals to advance our understanding of the pathophysiology, immunology, genetics and biobehavioral characteristics of treated and untreated HIV infection. The breadth, youth, experience and innovation of the UCLA MACS investigators, combined with the experience and commitment of the long-term staff, and our leadership of quality control procedures for immunologic and virologic measures and specimen processing, will continue to play an invaluable role in the success of the MACS over the next five years.

Project Number: 5U01SI035040-25

STI Screening as a Combined HIV Prevention Platform for MSM in Peru

Abstract: Periodic counseling, testing, and treatment for rectal sexually transmitted infections (STIs) provides a multi- dimensional platform to integrate behavioral and biological HIV prevention strategies for men who have sex with men (MSM) in Peru. Rectal STIs like gonorrhea and chlamydia are key risk factors for HIV acquisition among MSM, both as indirect behavioral markers of recent unprotected receptive anal intercourse (URAI), and as inflammatory factors that increase cellular risk for HIV co-transmission. However, there have been no prospective studies of interventions addressing the specific behavioral and biological risk factors associated with rectal STI transmission or the potential impact on HIV transmission risk of integrating rectal GC/CT screening with other prevention services. We will use nucleic acid testing to screen 750 behaviorally high-risk MSM for rectal gonorrheal and/or chlamydial (GC/CT) infection. GC/CT-positive subjects will receive single-dose antibiotic treatment and either single-session Personal Cognitive Counseling (PCC) (n=50) or standard post-test counseling (n=50). A GC/CT-negative control group (n=50) will also be enrolled to compare biological outcomes including changes in levels of inflammatory cytokines following rectal STI. Aim 1: To adapt a Personalized Cognitive Counseling (PCC) model for use with MSM in Peru. Aim 2: To adapt and pre-test the SJEI and behavioral assessment instruments for use with MSM in Peru. Aim 3: To pilot a combined HIV prevention intervention based on rectal STI counseling, testing, and treatment for MSM in Peru. Estimates of feasibility/acceptability of the intervention, GC/CT prevalence/re-infection rate and the effect on behavioral and biological mediators of HIV infection will be used to plan an R01 evaluation of rectal STI surveillance as HIV prevention for MSM in Peru.

Project Number: 5R01MH105272-03

The Influence of PreP Stigma Among Black and Latino MSM PreP Adopters

Abstract: Pre-Exposure Prophylaxis (PrEP) is a biomedical HIV prevention strategy with the potential to reduce the rate of new HIV infection among black and Latino men who have sex with men (BLMSM), two populations at the center of the U.S. HIV/AIDS epidemic. However, the social stigma currently associated with the use of PrEP (i.e. PrEP stigma) may negatively influence PrEP disclosure, diffusion, adherence and retention among BLMSM who adopt PrEP. The controversy and contention surrounding the implementation of PrEP in the gay community has led to the stigmatization of PrEP and those who use it. PrEP users may experience PrEP stigma in the form of negative perceptions (e.g., being judged, being unfairly treated), stigmatizing attributions (e.g., promiscuous, sexually irresponsible, mistakenly identified as HIV-positive), and stigmatizing practices (e.g., rejection, prejudice, discrimination) from friends, sex partners, providers and others. The goals of this study are to explore the nature and extent of PrEP stigma among BLMSM who have adopted PrEP and to assess its influence on PrEP disclosure, adherence and retention, and the diffusion of PrEP information to other potential BLMSM PrEP consumers. The specific aims of this study are: 1) to examine how BLMSM PrEP adopters experience PrEP stigma (e.g., anticipated, internalized, enacted); 2) to assess the extent and context of PrEP disclosure and dissemination of PrEP information by BLMSM PrEP users to other potential BLMSM PrEP consumers; and 3) to examine the influence of PrEP stigma, over time, on adherence and retention to PrEP among BLMSM PrEP adopters. To achieve these aims, this qualitative study will involve conducing in- depth interviews with 50 black (N = 25) and Latino (N = 25) MSM PrEP adopters and 20 black (N = 10) and Latino (N = 10) MSM non-PrEP adopters. BLMSM PrEP adopters will complete both a baseline and a 6-month follow-up interview. Follow-up interviews will assess changes in PrEP retention, adherence, disclosure and dissemination. Interviews with BLMSM non-PrEP adopters will elicit information about anticipated PrEP stigma and how this may have influenced decisions to seek or not seek PrEP. Interviews will also be conducted with 20 medical providers to assess their perceptions of PrEP and PrEP stigma and concerns about the implementation of PrEP. The findings from this study will inform the development of intervention activities that seek to prevent or mitigate the negative social experiences associated with PrEP adoption and to optimize diffusion and retention to PrEP among minority MSM.

 

Project Number: 5R21MH107339-02

https://reporter.nih.gov/search/drZGTF3vwkCaElbYrQowKQ/project-details/9266828

 

 

Contact PI/ Project Leader

BROOKS, RONALD ANDREW, ASSISTANT PROFESSOR (rabrooks@mednet.ucla.edu)

 

 

Organization

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

 

PUBLIC HEALTH RELEVANCE: Pre-Exposure Prophylaxis (PrEP) has the potential to reduce the number of new HIV infections among high-risk black and Latino men who have sex with men (BLMSM). However, the stigma attached to the adoption of PrEP may negatively influence PrEP disclosure, diffusion, adherence and retention among BLMSM who adopt PrEP. The findings from this study will inform the development of intervention activities that seeks to prevent or moderate the negative social experiences associated with PrEP adoption and facilitate diffusion, adherence and retention to PrEP among minority MSM.

 

 

Project Start Date:26-April-2016

Project End Date: 31-March-2019

Budget Start Date: 01-April-2017

Budget End Date: 31-March-2019

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE OF MENTAL HEALTH / FY Total Cost by IC: $156,526

Siempre Seguire: A Pilot Intervention to Improve Coping With Discrimination and Adherence Among HIV-Positive Latino MSM

Abstract: HIV-related disparities in diagnosis and disease outcomes persist among Latinos, and Latinos living with HIV show a lower percentage of viral suppression compared to the general HIV-positive population. A growing body of work suggests that stigma and discrimination contribute to health disparities, especially among people living with HIV, who may experience discrimination due to multiple stigmatized identities related to HIV- serostatus, race/ethnicity, and sexual orientation. Internalized stigma and discrimination may lead to health- related disparities by increasing detrimental physiological stress responses, resulting in maladaptive coping and poor health behaviors, including non-adherence to treatment. Moreover, the chronic stress of discrimination may weaken immune function, leading to worse HIV outcomes, including increased HIV viral load. In the proposed research, we will integrate adherence skills-building strategies into a recently developed intervention, Siempre Seguiré, a 7-session group cognitive behavioral therapy (CBT) intervention for HIV- positive Latino men who have sex with men (LMSM) that aims to improve adaptive coping responses to discrimination. In a small pilot of 30 participants, the intervention was associated with improved coping at follow-up as compared to baseline. However, this pilot did not include a control group, did not address or examine HIV-related behaviors and outcomes such as adherence, retention in care, and viral load suppression, and had a very low sample size. Thus, in the proposed research, we will conduct a larger pilot study in which preliminary effects on HIV outcomes can be assessed. The specific aims are: (1) To modify and refine Siempre Seguiré, a newly developed culturally congruent CBT group intervention for HIV-positive LMSM, to include strategies for antiretroviral treatment adherence and retention in HIV care; and (2) To conduct a small randomized pilot of Siempre Seguiré to examine feasibility and acceptability, as well as to explore preliminary effects on: (a) coping responses to discrimination; and (b) antiretroviral treatment adherence, viral load suppression, and HIV care retention, among LMSM living with HIV. In Phase 1, we will work with HIV treatment adherence intervention experts and key stakeholders, including a community advisory board, to refine our pilot intervention as needed and update our manual to integrate information and skills building regarding HIV treatment adherence and retention in care. In Phase 2, we will conduct a small randomized controlled trial of 80 participants (40 intervention participants divided evenly over 4 intervention groups vs. 40 wait-list control participants). To our knowledge, our study will be the first to test an intervention that addresses coping with discrimination from multiple identities. Our proposed research is consistent with the Institute of Medicine report, The Health of Lesbian, Gay, Bisexual, and Transgender People, which recommends developing interventions to address racial disparities and mental health effects of discrimination among sexual minorities.

 

Project Number:  1R34MH113413-01A1

https://reporter.nih.gov/search/NfaaiDsLWUizEGUyXRmd4w/project-details/9407123

 

 

Contact PI/ Project Leader

BOGART, LAURA M, SENIOR BEHAVIORAL SCIENTIST (LBOGART@RAND.ORG)

 

 

Organization

RAND CORPORATION

 

 

PUBLIC HEALTH RELEVANCE:  Latinos in the U.S., especially those who are men who have sex with men, show HIV-related disparities, tending to be diagnosed at a later disease stage, leading to delays in care entry and antiretroviral treatment use, and lower rates of viral suppression. No culturally congruent interventions have been developed to address stress resulting from discrimination, a key contributor to disparities in HIV outcomes among Latino men who have sex with men. We propose to integrate adherence skills-building into a recently developed intervention that addresses coping with discrimination among Latino men who have sex with men.

 

 

Project Start Date:01-August-2017

Project End Date: 31-May-2020

Budget Start Date: 01-August-2017

Budget End Date: 31-May-2018

 

 

NIH Categorical Spending

Funding IC: NATIONAL INSTITUTE OF MENTAL HEALTH/ FY Total Cost by IC: $194,834

Assessing Willingness to Test for HIV among Men who have Sex with Men using Conjoint Analysis

Project Name: Assessing Willingness to Test for HIV among Men who have Sex with Men using Conjoint Analysis: Implications for Testing and Treatment for Prevention of HIV Transmission

Brief overview: Various HIV testing methods currently available all have advantages and drawbacks.  In order to increase consumers’ HIV testing uptake, identifying key attributes influencing willingness to test for HIV is critical. MSM have significantly lower rates of HIV testing than the rest of the US population, despite reporting similar rates of risk behaviors. This study used conjoint analysis to provide an empirical basis for determining strategies to increase HIV testing uptake among MSM in Los Angeles, thus contributing to the feasibility of the “test and treat” initiative in Los Angeles. PrEP

Targeted Risk Group: Men who have sex with men (MSM)

Geographical Location: Los Angeles, CA

Intervention Model:  Cross-sectional study assessing willingness to test for HIV using conjoint analysis

Research methods: From June 2011 to September 2011, 75 MSM aged 18 and over were recruited from the Los Angeles Gay and Lesbian Center (LAGLC) to participate in a one-time conjoint analysis exercise to gather information around their HIV testing preferences.  Each hypothetical HIV testing scenario (conjoint) consisted of specific combination of seven dichotomous attributes.  We found a broad range of willingness to test (WTT) for HIV scores across the eight hypothetical HIV testing scenarios (range: 32.33 – 80.33).  The HIV testing scenarios with the highest WTT score had the following attribute profile: test given at home, free, blood collection, results available immediately, anonymous, results can be given by phone, and counseling given in-person by a counselor.  The HIV testing scenario with the lowest WTT score had the following attribute profile: test given at home, costs $50, blood collection, result available in 1-2 weeks, anonymous, results given in person, and counseling information on a brochure with an option to call.  Three attributes had a significant impact on influencing MSM’s decision to get tested for HIV.  Price had the biggest impact (impact score=31.42), followed by timeliness of results (Impact score=13.91) and location (Impact score=10.25).  Impacts of other four attributes on WTT score were not statistically significant.

Local Significance: This pilot study provided a vital first step in providing population-specific data on willingness to test for HIV among MSM in Los Angeles.  The findings will be valuable in informing HIV testing research and policy communities on 1) consumer reactions to different attributes of HIV testing, 2) the design of social marketing campaigns to facilitate HIV testing uptake, and 3) the design of new HIV testing methods to ensure uptake.

Doxycycline Prophylaxis or Incentive Payments to Reduce Syphilis among HIV-infected Men Who Have Sex with Men

This pilot study will investigate the feasibility of conducting a large, randomized trial comparing a structural intervention to contingency management to reduce incident syphilis infections in an especially high risk group: HIV+ men who have sex with men (MSM) who have had syphilis twice or more since their HIV diagnosis. Subjects will be randomized to receive either QD doxycycline as syphilis prophylaxis or a financial incentive to remain STI free.

We will : 1) measure adherence to study visits in both arms; 2) measure adherence to the prophylaxis regimen; 3) measure any changes in risk behaviors among study participants and 4) to the extent possible in a small pilot study of short duration, compare effectiveness of doxycycline with that of a monetary incentive for remaining STI free.

Targeted Risk Group

 HIV+ men who have sex with men (MSM) who have had syphilis twice or more since their HIV diagnosis.

Intervention Model

Subjects will be randomized to receive either 1) Doxycycline, 100 mg. to be taken once daily or 2) an incentive for remaining STI free.

Local Significance 

Results of this study can be used to inform public health policy and programs to reduce risk of STI and HIV transmission among HIV+ “core transmitters,” and can also be easily extended to HIV negative MSM with repeated STIs. With the preliminary data from this study we hope to apply for further funding to support a larger, multisite definitive study incorporating one or both of the current interventions.