This study will evaluate a status-neutral integrated strategy to improve access to and uptake of HIV prevention and treatment services for the highest HIV incidence (HHI) men who have sex with men (MSM) in participating communities. The ultimate goal is to establish a strategy to reduce HIV incidence among HHI MSM in the southern United States (US) by increasing the number of HHI MSM accessing prevention and treatment services, increasing uptake and use of pre-exposure prophylaxis (PrEP) among those living without HIV and increasing retention in care, and thus viral suppression, among those living with HIV.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
PREVENTION
Masking
NONE
Enrollment
2,700
This component will use a community coalition program as its base model for reducing structural barriers, shaping community social norms and raising awareness to reduce HIV among HHI MSM. This will be achieved through: 1) facilitating a reduction in social, structural, and policy barriers to HIV testing, PrEP, and viral suppression through fostering collective efficacy, promoting norms within the local service sectors (e.g., social, legal, economic, etc.), and advancing advocacy efforts that support the strategic prioritization of access to resources and services for HHI MSM; and 2) amplifying awareness, education, and capacity building around HIV prevention and treatment resources and messaging (including other HPTN 096 components).
A robust social media strategy will be used to reach and engage HHI MSM throughout each participating community. Utilizing a multitude of social media communication and marketing tactics, social media content will be used to educate and empower HHI MSM so that they can make informed decisions and behavioral changes to stop HIV acquisition and transmission, with emphasis on accessing HIV prevention and treatment services, the uptake of PrEP and the importance of staying engaged in care and achieving viral suppression. In addition, the strategy will promote other study components, encouraging HHI MSM to engage in care at PHASE healthcare facilities (HCFs), seek help from peer supporters and take advantage of the environmental changes put in place via the health access coalitions.
FHI 360
Durham, North Carolina, United States
To evaluate whether the HPTN 096 integrated strategy increases the number of HHI MSM clients at PHASE healthcare facilities.
Number of HHI MSM with a visit at the HCF in the previous 12 months (Source: EMR).
Time frame: Month 12
To evaluate whether the HPTN 096 integrated strategy increases retention in care among HHI MSM living with HIV at PHASE healthcare facilities.
Number of HHI MSM living with HIV with at least two HIV medical visits to the HCF at least 90 days apart within the previous 12 months (Source: EMR)
Time frame: Month 12
To evaluate whether the HPTN 096 integrated strategy increases PrEP prescriptions for HHI MSM not living with HIV at PHASE healthcare facilities.
Any PrEP prescription among all HHI MSM without HIV with a medical visit at the HCF within the previous 12 months (Source: EMR).
Time frame: Month 12
To evaluate whether the HPTN 096 integrated strategy increases viral suppression (<200 copies/mL) in HHI MSM living with HIV at PHASE healthcare facilities.
Viral suppression of the most recent viral load done among all HHI MSM living with HIV who had a viral load measurement at the HCF in the previous 12 months (Source: EMR).
Time frame: Month 12
To evaluate whether the HPTN 096 integrated strategy increases PrEP initiation, adherence and persistence for HHI MSM not living with HIV at PHASE healthcare facilities.
Self-report of PrEP initiation and adherence in the previous 12 months (Source: Cross-sectional assessment in sample of HHI MSM at PHASE HCFs \[questionnaires\])
Time frame: Months 4, 15, 27
To evaluate whether the HPTN 096 integrated strategy increases PrEP initiation, adherence and persistence for HHI MSM not living with HIV at PHASE healthcare facilities.
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Peer supporters, who may possess a shared and/or lived experience, will provide HHI MSM with emotional and practical support, using a HIV-status neutral approach, as well as share information on locally available sexual health and HIV-related resources and support services. Peers may provide support in-person or virtually and may be housed at local community-based organizations. In addition, when appropriate, the use of PHASE HCFs will be encouraged for those seeking healthcare services.
The PHASE component is an HCF-level practice improvement program designed to enhance the provision of healthcare services for HHI MSM. PHASE aims to create an autonomy-supportive healthcare environment that supports HHI MSM engagement in HIV-related care and services and helps to promote increased HIV and sexually transmitted infection testing, PrEP and antiretroviral therapy uptake, retention in care, and viral suppression rates for HHI MSM. The primary study outcomes will be collected at all HCFs participating in PHASE.
Repeat PrEP prescriptions among HHI MSM not living with HIV in the previous 12 months (Source: EMR).
Time frame: Month 12
To assess changes in the experience of autonomy support among HHI MSM at PHASE healthcare facilities.
Self-reported scale measuring autonomy support (Source: Cross-sectional assessment in sample of HHI MSM at PHASE HCFs \[questionnaires, healthcare climate section\])
Time frame: Months 4, 15, 27
To assess changes in the experience of autonomy support among HHI MSM at PHASE healthcare facilities.
Individual-level qualitative data with a subset of HHI MSM exploring autonomy support (Source: Cross-sectional assessment in sample of HHI MSM at PHASE HCFs \[qualitative interviews\]).
Time frame: Month 17 and 27
To assess how autonomy support, social support, stigma, barriers to healthcare and individual agency among HHI MSM at PHASE healthcare facilities are associated with engagement in care (including PrEP prescription and viral suppression).
Self-reported data related to autonomy support, social support, stigma, barriers to healthcare, individual agency (Source: Cross-sectional assessment in sample of HHI MSM at PHASE HCFs \[questionnaires\])
Time frame: Months 4, 15, 27
To assess how autonomy support, social support, stigma, barriers to healthcare and individual agency among HHI MSM at PHASE healthcare facilities are associated with engagement in care (including PrEP prescription and viral suppression).
Any PrEP prescription in last 12 months for HHI MSM not living with HIV (Source: Cross-sectional assessment in sample of HHI MSM at PHASE HCFs \[case report forms\])
Time frame: Months 4, 15, 27
To assess how autonomy support, social support, stigma, barriers to healthcare and individual agency among HHI MSM at PHASE healthcare facilities are associated with engagement in care (including PrEP prescription and viral suppression).
Viral load suppression and retention in care in last 12 months in HHI MSM living with HIV (Source: Cross-sectional assessment in sample of HHI MSM at PHASE HCFs \[case report forms\]).
Time frame: Months 4, 15, 27