Optimizing HIV PrEP Decision Support for Adolescents and Young Adults with Unhealthy Substance Use

About This Grant

PROJECT SUMMARY/ABSTRACT In the United States, adolescents and young adults (AYA) account for a disproportionate number of new HIV infections. In particular, AYA have unique vulnerability for HIV related to unhealthy substance use (USU) through a variety of mechanisms including: USU at the time of sex resulting in a greater risk for engaging in condomless sex or sex with multiple partners. A major factor driving elevated risk for HIV in AYA is poor HIV pre-exposure prophylaxis (PrEP) uptake. Although PrEP is >95% effective in preventing HIV infection, PrEP uptake has been poor in AYA despite a disproportionate burden of HIV infection among this population. Integrating PrEP delivery within the healthcare settings where AYA with USU already receive their sexual health services is a promising opportunity for PrEP scale-up. One strategy that has the potential to improve the delivery of PrEP to AYA with USU in healthcare settings, is a structured decision aid (DA). In the shared decision-making (SDM) literature, DAs are most applicable to decisions that are sensitive to patient values and preferences. DAs remain underutilized to support PrEP uptake for AYA. PrEP uptake represents a modifiable risk factor for HIV transmission among AYA with USU. Thus, a theory-driven, youth-informed, digital SDM tool such as a PrEP DA may be a critical strategy for PrEP uptake to ultimately decrease rates of HIV infection among AYA with USU. My long-term goal is to become an independent clinician- investigator in health services and implementation science research focused on with a research program centered on optimizing HIV prevention and PrEP delivery for AYA with USU. Ultimately, the overall objective of this application is to adapt and pilot test a DA that may be integrated within AYA health services to enhance decision making about PrEP among AYA with USU through the following aims: 1) Adapt an existing PrEP DA using the ADAPT-ITT Framework, in order to specifically address the unique needs of AYA with USU, by 1a. applying Delphi methodology with experts in adolescent primary care, HIV and addiction medicine to build consensus around the DA content. 1b. adapting the DA prototype and 1c. conducting usability testing sessions with AYA with USU to inform the DA delivery strategy and 2) Conduct a single-arm, non-randomized pilot trial to test the feasibility and acceptability of the PrEP DA with AYA with USU at risk for HIV acquisition and their clinicians. This research and training plan target NIDA’s priority to seek applications to inform, develop or test implementation science approaches to scale-up and sustain evidence- based HIV intervention among people who use drugs, incorporating the prevention continua. The proposal is aligned with the Presidential Ending the HIV Epidemic Initiative’s goal of reducing new HIV infections in the U.S. by 90% by 2030 by protecting individuals at risk for HIV using proven prevention approaches. The research and training in this application will prepare the candidate for an independent scientific career improving health outcomes among AYA with USU who have unaddressed risk of HIV acquisition.