Grant: Operating Grant - HIV/AIDS CBR Program - General

Men who have sex with men (MSM) continue to bear a major burden of HIV infections in Canada. Pre-exposure prophylaxis (PrEP) is a new HIV prevention approach involving daily use of HIV medication, and has been shown to reduce HIV infections in clinical trials. There are now urgent global calls for PrEP demonstration projects studying how to deliver PrEP in the real world. We are thus launching PREPARATORY-5, a pilot 1-year PrEP trial among 50 Toronto MSM, and Canada's first PrEP demonstration project. However with the emergence of PrEP has come increasing uncertainty among community based organizations (CBOs) regarding their role in the changing HIV prevention landscape. In particular, there are concerns that the historical successes of community in HIV prevention could be overshadowed by a "medicalized" HIV prevention field. Yet our own CBOs, and our prior survey research among CBOs nationwide, also show that CBOs are keen to be involved in PrEP. We contend that CBOs will in fact be vital in maximizing the clinical and public health benefits of PrEP, and will evaluate the specific roles of CBOs in PrEP rollout in this proposal using the PREPARATORY-5 trial as a research platform. Specific objectives are: 1.To measure the volume, rate and HIV risk level of referrals made to the PREPARATORY-5 trial by partner CBOs, relative to self-referral strategies, in order to quantify the important role of CBOs in linking high-risk clients to PrEP. 2.To screen for syndemic health problems (eg. depression, social anxiety, substance abuse, partner violence) among MSM screened for the trial, in order to document the need for CBO-based services addressing these challenges among potential PrEP candidates. 3.To measure the impact on biological measures of PrEP medication adherence of a CBO-delivered PrEP adherence support intervention. 4.To define a CBO action agenda on what PrEP-related CBO services are needed to support PrEP rollout as part of an integrated KTE plan.