Grant: CIHR REDI Early Career Transition Award - HIV/AIDS and STBBI

Almost 1 in 4 Ontarians living with HIV are Black people. This is worrisome, because Black people in Ontario make up just 4.7% of the population but accounts for 25% of new HIV infection. Black communities in Ontario are disproportionately impacted by the HIV epidemic. To reverse this trend, an effective method to increase the uptake and use HIV prevention medication - HIV pre-exposure prophylaxis (PrEP)- must be developed and implemented in Black communities in Ontario. PrEP is safe and very effective to prevent HIV infection, but the uptake and use in Black communities in Ontario is very low. Previous efforts to increase the use of PrEP in Black communities has failed because they only targeted isolated barriers, facilitators, and contextual factors affecting the uptake and use of PrEP in Black communities. Therefore, the overall aim of this study is to increase the proportion of PrEP-eligible Black people who will accept and use PrEP for HIV prevention through the design, development and implementation of a theory-driven intervention strategy that can be replicated in other Black communities in Canada. First (in Phase I), I will mobilize and utilize knowledge from various sources to design, refine, develop and evaluate the quality of a theory-driven intervention strategy - Peer-Facilitated Decision Making and Referral Support (PrEP-DMR). Then, in Phase II of the study, I will pilot-test the PrEP-DMR with trained peer support workers (Strategic Workers of African and Caribbean Council on HIV/AIDS in Ontario) in selected AIDS Service Organizations (ASOs)/Community Health Centers, to determine acceptability, feasibility, and potential impact on clinical outcomes (PrEP uptake and use). Lessons learnt from the pilot study will guide the design of full implementation trial . Outcome of this study will inform both practice and policy changes, as well as inform the plan for scale-up of the intervention model in other ACB communities in Canada.