A n intensive intervention comprised of automated messaging and monitoring (AMMI) via text-message, peer support, and coaching resulted in improved and sustained PrEP uptake among young gay, bisexual, transgender, and gender-diverse patients aged 12-24, according to findings presented at IAS 2023, the 12th International AIDS Society Conference on HIV Science. Mary Jane Rotheram, PhD, and colleagues examined the level of intervention required to improve uptake of healthcare, including PrEP, postexposure prophylaxis, and engagement with social services, among 895 predominantly Black and Latino gay, bisexual, transgender, and gender diverse patients aged 12-24. They randomly assigned participants to interventions in a four-arm design: AMMI (n=313); AMMI plus peer support via private social media (AMMI-PS; n=205); AMMI plus strengths-based telehealth coaching (AMMI-C; n=196); or AMMI plus peer support and coaching (AMMI-PS-C; n=181). Outcomes were assessed over 24 months. Dr. Rotheram and colleagues reported significant benefits for two outcomes. Initial PrEP uptake matched that of youth rates nationally (current users, 11.3%; lifetime users, 18.8%) and increased at 4 months to 15% across intervention arms. Uptake continued to increase in the AMMI-PS-C arm over time (vs AMMI control: OR, 2.35; 95% CI, 1.27-4.39). By 12 months, more than 23% of participants in the AMMI-PS-C arm reported PrEP use, with some fall-off at 20-24 months, which was concurrent with the COVID-19 pandemic. Approximately half of the participants in the study received no ancillary services during each assessment period. Participants in the AMMI group had significantly higher use of services when recruited; however, over time, the rate of service use remained mostly consistent in the AAMI-PS-C group. “The most intensive intervention group receiving AMMI, peer support, and coaching improved and sustained PrEP use and services utilization over time compared [with] other groups,” Dr. Rotheram and colleagues wrote Multiple barriers impact access to PrEP among Latino sexual minority men (LSMM) and contribute to HIV disparities, according to findings published in AIDS Care. Audrey Harkness, PhD, and colleagues examined determinants of PrEP use and HIV testing among LSMM as well as differences across subgroups, such as age and immigration history. Cost, knowledge, and perceptions of one’s need for PrEP as well as the therapy’s benefits were identified as key determinants overall. The researchers reported variations in determinants across age groups, including cost, affordability, navigation support, and normalization, and immigration status, including language, immigration concerns, and knowledge of HIV. Mistrust and concerns were barriers related to PrEP but not HIV testing, and there were common and unique multilevel factors reported across prevention services and various subgroups. “Language, cost, and clinic/system issues are key barriers in accessing HIV prevention that should be considered when developing implementation strategies to enhance the reach of these services to LSMM,” Dr. Harkness and colleagues wrote.
