Estimating the Impact of a Multilevel, Multicomponent Intervention to Increase Uptake of HIV Testing and Biomedical HIV Prevention

Columbia Univ New York Morningside, New York NY

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Abstract

Increasing access to and uptake of biomedical prevention (PEP/PrEP) is critical to ending the epidemic in the United States (US) among groups experiencing higher HIV impact. This is particularly true for people who would benefit from more consistent HIV testing, which is now recommended every 3-6 months for key groups and is the gateway to biomedical treatment and prevention. NYC is the metropolitan area in the US with the largest number of newly diagnosed HIV infections among such groups and 89-94% of all people living with HIV/AIDS (PLWHA) in the US reside in urban areas. Although such areas often have robust testing and PEP/PrEP dissemination programs, consistent testing and PEP/PrEP uptake is still low. 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 challenges to access and/or cognitive antecedents (intentions, motivation, skills) to behavior; few focus on reducing challenges to testing/PEP/PrEP access via self-testing, self-assessment and -care and navigation to services. 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 community-based organization-delivered HIV prevention programming to support HIV testing and PEP/PrEP uptake. We will estimate additive and interactive effects of the components, which include a single-session, HIV self-testing education session, a three-session PEP/PrEP navigation enhancement component, and a social and print 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). To achieve the study aims, we will enroll 480 PrEP-eligible individuals from groups experiencing higher HIV impact (aged 18-65) living in the New York metro area 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 people vulnerable to HIV.