Pre-Exposure Prophylaxis

How can we leverage biomedical prevention to promote liberation and sexual health? 

The advent of pre-exposure prophylaxis (PrEP) in 2012 represented a tremendous opportunity to “reboot” our approach to HIV prevention messages and intervention, one that has still not yet been fully realized. At HART, our work focuses on leveraging PrEP to pioneer new prevention strategies and paradigms that emphasize health and sex positivity, as opposed to risk and fear. We work with Departments of Health, community-based organizations, and clinical settings to develop and evaluate new programs. Our NIH-funded PrEP demonstration project, called SPARK (see below) was the first PrEP demonstration project in New York City, and the first study to develop an effective behavioral intervention to support PrEP adherence. Since then, we have expanded our work to focus on emerging PrEP modalities, novel approaches to PrEP messaging and communication, and strategies for supporting PrEP sustainment. Much of our implementation science work is also focused on PrEP dissemination, click on the implementation science tab to learn more. 

Funded Research Projects

Optimizing behavioral economics-based nudges as implementation strategies to improve HV prevention uptake
Funded by the National Institutes of Health (NIAID), CFAR Supplement Grant | P30AI124414-07 (Sarit Golub/Viraj Patel, MPI)
August 2022 - April 2024

This CFAR EHE supplement pilot is designed to address the persistent health equity gaps in PrEP uptake and sustainment among Black and Latino sexual minority men (BLSMM) by focusing on behavioral economics and the psychology of motivation. A core concept within behavioral economics is the extent to which individuals are influenced by “choice architecture,” i.e. the subtle – often unconscious – cues that move individuals toward (or away from) a given decision. This project uses a sequential, mixed method design to identify specific strategies (“nudges”) that are directly designed to address the cognitive, behavioral, and heuristic biases that limit uptake of HIV-related services. In partnership with the Montefiore Prevention Program, Voces Latinas, and OASIS (Latino Commission on AIDS) we will (a) conduct stakeholder engagement sutdios to identify behavioral economic nudges most relevant to HIV prevention; (b) conduct an online survey of 400 BLSMM to understand the perceived relevance and utility of the different nudges identified, and (c) conduct a second round of stakeholder engagement studios to present survey findings and operationalize a set of specific strategies to incorporate the most feasible, acceptable, and preliminary impactful nudges into HIV service delivery programs.

Patient-Focused PrEP Management to Increase Coverage for Highest Priority Patients in Primary Care in a High Prevalence Jurisdiction
Funded by the National Institutes of Health (NIAID), CFAR Supplement Grant | P30AI124414-05 (Viraj Patel/Sarit Golub, MPI)
September 2020 - April 2023

This project was designed to examine the impact of a series of patient-centered, low-threshold implementation strategies on PrEP sustainment among Black and Latino sexual minority men (BLSMM). The project was based in eight FQHCs that are part of the Montefiore Medical Group in Bronx, New York. We tested the impact of three strategies: (a) provider education, including a newsletter and a training series; (b) development and roll-out of provider “smart-phrase” templates in the electronic medical record; and (c) implementation of targeted outreach and navigation of PrEP patients who had fallen out of care. Primary outcomes include PrEP sustainment and sexual health care sustainment (i.e., STI and HIV testing regardless of PrEP prescription). Supplemental analyses are focusing on the association between PrEP prescription patterns and patient retention, and the relative impact of implementation strategies on specific groups of patients.

Project IMPrOVE: Understanding Implementation of HIV Prevention Navigation in STD Clinics (COMPLETED)
Funded by the National Institutes of Health (NIMH) | R01MH106380-02S1 (Sarit Golub, PI)
September 2016 - November 2019

Project IMPrOVE was a partnership between HART and the New York City Department of Health and Mental Hygiene (DOHMH) to evaluate a new model of STD clinic-based PrEP navigation and implementation. We want to understand how this new intervention works -- Which patients does it help most and why? Which components of the program are most or least effective? How can program elements be modified to best serve highest priority patients? We are collecting data from patients who accept and refuse navigation services and following them over time. We are also using the Proctor Implementation Science Framework (Proctor et al., 2013) to operationalize program components, monitor fidelity, and better understand optimal outcomes.

SPARK: Intervention to Enhance PrEP Uptake and Adherence in a Community Setting  (COMPLETED)
Funded by the National Institutes of Health (NIAAA) | R01AA022067 (Sarit Golub, PI)
September 2012 - July 2017

SPARK was a collaboration between HART and Callen-Lorde Community Health Center (CLCHC), the largest LGBT health center in New York City. SPARK was the first PrEP demonstration project in NYC and was designed to develop a protocol for PrEP to be integrated into regular care at a community-based health center. In addition, SPARK developed and tested two brief behavioral interventions, one focused on sexual health that assists patients in deciding whether or not to take PrEP, and the other designed to support adherence among patients who choose PrEP. This intervention was the first to demonstrate efficacy in improving PrEP adherence among patients (see below), and has demonstrated impacts on sexual wellbeing (see spotlight). The protocols and materials developed in SPARK were adapted as a series of implementation trainings for the New York City Health Department, and have been credited with providing the “foundation” upon which NYC’s PrEP implementation plan was built.

REsearch Spotlight

Effective intervention to improve PrEP adherence

In February 2017, Dr. Golub presented findings at the Conference on Retroviruses and Opportunistic Infections (CROI) on the effectiveness of the SPARK brief behavioral counseling interventions on PrEP adherence. The SPARK intervention is the first PrEP adherence intervention to demonstrate an impact on levels of PrEP in patients' blood (i.e., objective "proof" that they are actually taking the medication). In SPARK, patients were randomized to receive either: a) a Sexual Health Intervention (SHI); b) an Adherence Intervention(AI); c) both interventions (SHI/AI); or d) treatment as usual (TAU), i.e., simply educational materials about PrEP and the importance of adherence.

As demonstrated in this figure, between 94% and 98% of patients who received one (or both) of the SPARK interventions had optimal adherence to PrEP in the first three months after starting it, compared to only 85% of patients who did not receive the interventions. These data suggest that brief behavioral interventions can work to improve PrEP adherence in a real-world setting. 

Download the CROI presentation of these data.

Read press coverage of the research in Betablog or Poz Magazine.

Research Projects

SPARK: Intervention to Enhance PrEP Uptake and Adherence in a Community Setting  (R01AA022067; Golub, PI)

SPARK is a collaboration between HART and Callen-Lorde Community Health Center (CLCHC), the largest LGBT health center in New York City. SPARK was the first PrEP demonstration project in NYC and was designed to develop a protocol for PrEP to be integrated into regular care at a community-based health center. In addition, SPARK developed and tested two brief behavioral interventions, one focused on sexual health that assists patients in deciding whether or not to take PrEP, and the other designed to support adherence among patients who choose PrEP. This intervention is the first to demonstrate efficacy in improving PrEP adherence among patients. You can learn more about the SPARK interventions here. 

PrEPARE: Impact of PrEP Messaging on Comprehension, Acceptability, and Risk  (R01MH095565; Golub, PI)

PrEPARE combined theories and approaches from social psychology, health psychology, decision-sciences, and communications to test the impact of different messaging characteristics on patients' comprehension, interest, and motivations. We recruited over 500 gay/bisexual men and transgender women to evaluate PrEP messaging strategies and explore the association between PrEP-related attitudes and behavior.

Select Publications

Lelutiu-Weinberger, C. & Golub, S.A. (2016). Enhancing PrEP Access for Black and Latino men who have sex with men. Journal of Acquired Immune Deficiency Syndrome, 73(5), 547-555.

Golub, S.A., Gamarel, K.E., & Lelutiu-Weinberger, C. (2016). The importance of sexual history taking for PrEP comprehension among young people of color. AIDS and Behavior, 1-10.

Collaborative Work

First PrEP demonstration Project in New york city

In collaboration with Callen-Lorde Community Health Center, we created the first PrEP demonstration project in New York City, called "SPARK" because of PrEP's potential to spark a change in the HIV epidemic. SPARK pioneered a model of sex-positive, patient-focused PrEP provision and was instrumental in the development of the larger PrEP program at CLCHC, which is now one of the largest PrEP providers in the country.  

Click here for the SPARK project website.