How can we leverage biomedical prevention to promote liberation and sexual health?
The advent of pre-exposure prophylaxis (PrEP), the first biomedical prevention strategy, represents a tremendous opportunity to reboot our approach to HIV prevention messages and intervention. At HART, our work focuses on leveraging PrEP to both pioneer new prevention strategies and approaches, and to draw attention to the need for new paradigms and narratives that emphasize health and sex positivity, as opposed as to risk and fear of disease. We work with Departments of Health, community-based organizations, and clinical settings to develop and evaluate new programs. Our NIH PrEP demonstration project, called SPARK (see below) was the first PrEP demonstration project in New York City, and is the first study to develop an effective behavioral intervention to support PrEP adherence. Much of our implementation science work is also focused on PrEP dissemination, click on the implementation science tab to learn more.
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.
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.
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.
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.