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Completed

NCT Number: NCT03674983

PrEP Seguro: Antiretroviral-based HIV Prevention Among Men at High Risk in Mexico

The objective of this R34 application is to prepare for testing innovative user-centered ways to promote PrEP adherence at scale. Our central hypothesis is that adherence to PrEP can be improved among MSW if PrEP is provided for free along with highly-tailored conditional economic incentives (CEI). The specific aims are: Aim 1: To refine the design of PrEP adherence intervention with user-centered conditional economic incentives to maximize sustained adherence behaviors through a user-responsive computerized survey (n=200). We incorporate quantitatively identified preferences for CEIs through a user- responsive computerized survey. We use conjoint analysis to understand preferences for CEI intervention components and how CEIs should be integrated into an optimal combination package to be tested in Aim 2. Aim 2: Measure the extent to which a user-centered CEI intervention can help MSW increase their adherence to free PrEP in a randomized controlled pilot (n=100). Among MSW who accept to take free PrEP, and return at month 1 for a second pill bottle, we will randomize n=100 MSW to either: standard of care (SoC: information, prescription, free PrEP) or CEI (SoC + incentives contingent on sufficiently-high adherence to PrEP). We will assess the primary outcome (biomarker of adherence using scalp hair analysis) at months 3 and 6, as well as secondary outcomes: clinic attendance/retention, medication possession ratio, self-reported PrEP use, and sexual behavioral disinhibition (number of partners, condom use, incident STI). Aim 3: Estimate the preliminary cost-effectiveness of incentives for PrEP adherence to maximize future policy and practice relevance of this promising intervention strategy. Our working hypothesis is that conditional economic incentives for PrEP adherence will be cost-effective in terms of cost per fully- adherent month on PrEP, cost per HIV infection averted, and cost per disability-adjusted life year saved when compared to controls not receiving the conditional incentives. The expected outcome of this R34 is a demonstration that is feasible to implement user-centered CEIs in this context, as well as preliminary efficacy and cost-effectiveness data. The project will have positive impact because it is a critical step toward scaled-up implementation of PrEP in this highly-at-risk population of MSWs in Mexico, with implications for other concentrated epidemics among MSW worldwide.

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Key information

Conditions

HIV Infections Blood-Borne Infections Communicable Diseases Genital Diseases Immune System Diseases Immunologic Deficiency Syndromes Infections Lentivirus Infections RNA Virus Infections Retroviridae Infections Sexually Transmitted Diseases Sexually Transmitted Diseases, Viral Urogenital Diseases Virus Diseases

Age range

18 year and older

Sex eligibility

Male

Study type

Interventional

Phase

Not applicable

Primary location

National Institute of Public Health (INSP) / Clinica Condesa

Mexico City, Mexico

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Male at birth and self-identifies as male at the time of enrollment
  • At least 18 years of age
  • Has tested negative for HIV in the past month
  • Demonstrates high risk of HIV acquisition defined as having had sex with penetration (oral or anal) with at least 8 male partners in past six months
  • Has exchanged or accepted money, drugs or gifts in exchange for sex on at least 8 occasions in the past month
  • Willing and capable of providing blood and scalp hair samples for assessments
  • Willing and able to provide written informed consent
  • Have successfully initiated PrEP and are returning for their second bottle of PrEP pills
  • Able to provide a home address or personal telephone number, or able to provide two personal contacts who will be able to know the patient's whereabouts during the study period

Exclusion criteria

  • Under 18 years of age
  • Unable to give informed consent due to severe mental or physical illness/substance intoxication at baseline visit
  • Presents with severe adverse reactions to PrEP
  • The subject will be excluded from the study at his own request for any reason since participation is voluntary

Treatment and study plan

Conditional Economic Incentive (CEI)

Behavioral

If hair testing shows that a participant has taken PrEP pills about 5-7 times in the previous week, he will receive a grade "A"; if he has taken PrEP pills about 3-4 times in the previous week he will receive a grade "B"; and if he has taken PrEP pills only 2 times or less, he will receive a grade "C". For those in the CEI group, if participant gets an A, he receives two additional prizes; if he gets a B, he receives one additional prize; and if he gets a C, he receives no additional prizes.

Primary outcomes

  1. ARV Hair Concentrations

    Time frame: 6 months

    Level of ARV (TDF/FTC) in scalp hair samples

Secondary outcomes

  1. Clinic attendance/retention

    Time frame: 6 months

    This is a measure of retention in care. As each participant finishes his 6-month study period, retention will be determined by number of quarterly care visits completed.

  2. Medication adherence

    Time frame: 6 months

    Medication Possession Ratio (MPR) is defined as the number of dispensed pills divided by the number of days between visits which will be derived from pharmacy refill records

  3. Questionnaire to Assess Self-reported PrEP Use

    Time frame: 6 months

    Self report adherence to assess for change in adherence.

  4. Reduction in HIV and STI incidence relative to control group

    Time frame: 6 months

    Male sex worker participants will be tested at baseline and 6-month follow-up for HIV and syphilis. Incidence rates for all infections at 6-month follow-up will be compared between the conditional economic incentive (CEI) group and the standard of care (SOC) group.

  5. Reduction in number of unprotected sex acts relative to control group

    Time frame: 6 months

    Male sex worker participants will be assessed at baseline and 6-month follow-up using self-report measures of frequency of protected and unprotected sex acts with clients. Changes in frequency at 6-month follow-up will be compared between the conditional economic incentive (CEI) group and the standard of care (SOC) group.

Sponsors and collaborators

Lead sponsor

Brown University

Other

Collaborators

  • Consorcio de Investigación sobre VIH/SIDA/TB (CISIDAT).
  • Mexican National Institute of Public Health
  • National Institute of Mental Health (NIMH)
  • University of California, San Francisco

Registry information

Important dates

Study start
2019
Primary completion
2021
Study completion
2021
First posted
Sep 18, 2018
Registry last updated
Aug 9, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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