240 Strategies used by trained Peer Mentors in an intervention designed to increase engagement in new modalities for HIV prevention

OBJECTIVES/GOALS: Peer supporters are frequently engaged to help people with marginalized identities access a range of health services, including newly developed interventions. Understanding how that individuals in these lay roles approach their interactions with clients may help to inform their future selection and training in order to support T3-T4 translation. METHODS/STUDY POPULATION: We examined the strategies and perspectives of Peer Mentors in an HIV/STI prevention intervention (Passport to Wellness, PtW) designed to encourage regular screening for HIV and sexually transmitted infections and the use of HIV biomedical prevention (pre- and post-exposure prophylaxis). Fifteen men were trained to serve as Mentors for this novel PtW intervention for Black sexual minority men (SMM) that was being tested in Los Angeles County. Surveys were conducted at the start of their training and both surveys and semi-structured qualitative interviews were conducted after the Mentors had provided peer services for several months. Thematic analysis was conducted on interview transcripts for the 10 men who actually served as program Mentors during the pilot study and small randomized trial of the intervention. RESULTS/ANTICIPATED RESULTS: Peer Mentors described trust, rapport, accountability, encouragement, and flexibility as key characteristics of successful mentor-mentee relationships. The Mentors, their peers, and the mentor training and intervention design facilitated these dynamics. Mentors established trust, rapport, and accountability in the first 1-2 sessions with mentees through self-disclosure, reassurance, non-judgement, and discussion of roles and expectations. They also reviewed the goals and referrals developed at baseline with each mentee and used this plan as an accountability tool throughout their sessions. Participants had also viewed an introductory video and read a short mentor biography prior to their first mentor meeting -- a step mentors felt increased participants’ enthusiasm and willingness to engage. DISCUSSION/SIGNIFICANCE: Despite similar histories and demographics that made them peers, the mentors had progressed beyond those they served and often approached interactions with mentees in a manner similar to that of academic mentors. Mentors’ expertise and life progress elevates their roles; additional tools from academic mentoring may aid their training and support

Exploring the preferences of a culturally congruent, peer-based HIV prevention intervention for black men who have sex with men.

Background HIV testing, treatment initiation and treatment adherence have been emphasised for Black men who have sex with men (BMSM). However, many BMSM do not get tested, obtain HIV treatment or adhere to treatment. It is essential to highlight barriers to HIV testing, treatment adherence and the ideal components for an intervention: peer mentors, socioeconomic resources and participant incentives.MethodsFive focus groups (n=24) were conducted among HIV-negative and HIV-positive BMSM aged ≥18 years in Los Angeles, California, USA to explore motivations and barriers to testing and treatment and the components of an ideal, culturally competent HIV testing intervention for BMSM.ResultsBarriers to HIV testing included fear and stigma associated with discovering a HIV-positive status and drug use. Motivations for testing included experiencing symptoms, beginning new relationships, perceptions of risk and peer mentors.ConclusionsFuture HIV prevention and treatment efforts should consider these components to improve health outcomes among BMSM

"Being downcast by society… adds to the stress levels and would explain why [we] smoke more.": Smoking among HIV-Positive Black Men Who Have Sex with Men.

Smoking causes more deaths among people living with HIV than HIV infection itself. Few smoking cessation interventions and studies of sexual minority communities have considered the lived experiences of Black men who have sex with men (BMSM) living with HIV. Before developing interventions for these men, we need to answer: How do experiences of discrimination and stigma influence their perceptions of smoking? This phenomenological study was led by a community-based organization. We conducted six focus groups with 53 BMSM living with HIV in Los Angeles. We used minority stress theory in the analysis and interpretation of the data. We identified two themes: (1) co-occurrence of race and sexual orientation stressors and smoking (e.g., "I feel like I'd be discriminated against sometimes because I'm gay and because I'm Black.") and (2) smoking as a reaction to HIV-positive status (e.g., "I know more people that started smoking after they found out they [had] HIV."). Participants smoked to cope with stressors around race, sexual orientation, and living with HIV. These findings challenge us to ensure that smoking cessation interventions address the personal and social concerns of BMSM living with HIV and help them identify healthier ways to cope with stressors

Small Randomized Controlled Trial of the New Passport to Wellness HIV Prevention Intervention for Black Men Who Have Sex With Men (BMSM).

We developed and tested Passport to Wellness (PtW), a client-centered intervention to improve engagement in HIV/STI prevention and services to improve social determinants of health among Black men who have sex with men (BMSM) using incentives and peer support. We assessed PtW's impact on HIV/STI screening and pre/post-exposure prophylaxis (PrEP/PEP) knowledge/uptake using a randomized trial that compared the full intervention to one lacking peer support. We compared changes within groups surveyed at baseline and 6 months. We enrolled 80 eligible BMSM, among 399 screened. Among retained participants (34 peer-supported; 27 comparison), overall increases were observed in HIV (30% to 87%; p < .001) and STI (28% to 80%; p < .001) testing within the prior 6 months, as well as in PrEP and PEP awareness, and PrEP use. Statistically significant between group differences were not observed. Tailored prevention planning, incentives, and addressing social determinants may help move Black MSM along the HIV prevention continuum

Mobile-Enhanced Prevention Support Study for Men Who Have Sex With Men and Transgender Women Leaving Jail: Protocol for a Randomized Controlled Trial.

BackgroundMen who have sex with men (MSM) and transgender women, particularly those who have experienced criminal justice involvement, have particularly high HIV burdens, and a majority of those in jail have substance use disorders (SUDs). MSM and transgender women also experience elevated rates of incarceration. Once community re-entry occurs, individuals are in a critical period for addressing potential risks of HIV and sexually transmitted infection (STI) acquisition and negative sequelae of substance use. Further, the impact experienced by one's social and sexual networks experienced at the time of detention and release have important health implications for MSM and transgender women.ObjectiveThe purpose of this study is to test a new intervention-Mobile-Enhanced Prevention Support (MEPS)-that involves a GPS-based mobile app called GeoPassport (referred to as GeoPass in practice), incentives, and peer support for promoting HIV prevention, substance use treatment, and use of related services.MethodsA two-arm, unblinded, randomized controlled trial will seek to enroll 300 HIV-negative MSM and transgender women, aged 18-49 years, with SUDs, who are either in jail or have recently left jail. Participants will be enrolled by study staff and randomized to the MEPS intervention group or usual care group. The intervention group will receive customized wellness goals in addition to GeoPass, cash incentives, and the support of a trained peer mentor for 6 months. Data collection will consist of a baseline survey and three follow-up surveys at 3, 6, and 9 months postenrollment, either in person or by phone or videoconference when necessary. The primary outcomes include establishing a primary care provider; being prescribed and adhering to pre-exposure prophylaxis (PrEP) for HIV; screening for HIV, STIs, and hepatitis C virus; and engagement in recommended treatment for SUDs. Secondary outcomes include obtaining treatment for any identified infections and avoiding recidivism.ResultsEnrollment began in November 2019 and study completion is expected in 2023.ConclusionsThis study will advance our knowledge base on patient navigation and peer mentor interventions. Peer navigation services have been studied for the treatment of HIV, but less often in the context of HIV and STI prevention among sexual and gender minority populations at the time of re-entry into the community from jail. The MEPS study will examine the acceptability and feasibility of combining peer mentor services with a mobile app to facilitate service utilization and participant-peer mentor communication. MEPS will assess patterns of PrEP uptake and utilization in MSM and transgender women leaving jail. The study will provide heretofore unavailable data from persons leaving jail regarding HIV PrEP, STI screening, substance abuse treatment, and service utilization patterns and experiences, including geocoded data for those in the intervention arm.Trial registrationClinicalTrials.gov (NCT04036396); https://www.clinicaltrials.gov/ct2/show/NCT04036396.International registered report identifier (irrid)PRR1-10.2196/18106

Mobile-Enhanced Prevention Support Study for Men Who Have Sex With Men and Transgender Women Leaving Jail: Protocol for a Randomized Controlled Trial (Preprint)

BACKGROUND Men who have sex with men (MSM) and transgender women, particularly those who have experienced criminal justice involvement, have particularly high HIV burdens, and a majority of those in jail have substance use disorders (SUDs). MSM and transgender women also experience elevated rates of incarceration. Once community re-entry occurs, individuals are in a critical period for addressing potential risks of HIV and sexually transmitted infection (STI) acquisition and negative sequelae of substance use. Further, the impact experienced by one’s social and sexual networks experienced at the time of detention and release have important health implications for MSM and transgender women. OBJECTIVE The purpose of this study is to test a new intervention—Mobile-Enhanced Prevention Support (MEPS)—that involves a GPS-based mobile app called GeoPassport (referred to as GeoPass in practice), incentives, and peer support for promoting HIV prevention, substance use treatment, and use of related services. METHODS A two-arm, unblinded, randomized controlled trial will seek to enroll 300 HIV-negative MSM and transgender women, aged 18-49 years, with SUDs, who are either in jail or have recently left jail. Participants will be enrolled by study staff and randomized to the MEPS intervention group or usual care group. The intervention group will receive customized wellness goals in addition to GeoPass, cash incentives, and the support of a trained peer mentor for 6 months. Data collection will consist of a baseline survey and three follow-up surveys at 3, 6, and 9 months postenrollment, either in person or by phone or videoconference when necessary. The primary outcomes include establishing a primary care provider; being prescribed and adhering to pre-exposure prophylaxis (PrEP) for HIV; screening for HIV, STIs, and hepatitis C virus; and engagement in recommended treatment for SUDs. Secondary outcomes include obtaining treatment for any identified infections and avoiding recidivism. RESULTS Enrollment began in November 2019 and study completion is expected in 2023. CONCLUSIONS This study will advance our knowledge base on patient navigation and peer mentor interventions. Peer navigation services have been studied for the treatment of HIV, but less often in the context of HIV and STI prevention among sexual and gender minority populations at the time of re-entry into the community from jail. The MEPS study will examine the acceptability and feasibility of combining peer mentor services with a mobile app to facilitate service utilization and participant–peer mentor communication. MEPS will assess patterns of PrEP uptake and utilization in MSM and transgender women leaving jail. The study will provide heretofore unavailable data from persons leaving jail regarding HIV PrEP, STI screening, substance abuse treatment, and service utilization patterns and experiences, including geocoded data for those in the intervention arm. CLINICALTRIAL ClinicalTrials.gov (NCT04036396); https://www.clinicaltrials.gov/ct2/show/NCT04036396 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/1810