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$4.9 Million NIDA-Funded Study to Examine a Behavioral Intervention to Optimize PrEP Adherence in Sexual Minority Men Who Use Stimulants

The National Institute on Drug Abuse awarded Adam Carrico, Ph.D., professor in the Miller School of Medicine’s Department of Public Health Sciences and director of the Division of Prevention Science and Community Health, a $4.9 million grant to conduct a multi-site randomized controlled trial in South Florida and San Francisco. Mallory Johnson, Ph.D., professor at the University of California San Francisco (UCSF) School of Medicine and co-director of the Center for AIDS Prevention Studies, will serve as the multiple principal investigators for this project who will lead the San Francisco site.

Sexual minority men – gay, bisexual, and other men who have sex with men – who also use stimulants, such as methamphetamine, cocaine, and crack-cocaine, display a three- to six-fold faster rate of HIV incidence. In fact, one in 10 sexual minority men who have been newly diagnosed with HIV report recent use of stimulants. There is a critical need to enhance the clinical and public health benefits of pre-exposure prophylaxis (PrEP) to prevent HIV in this high priority population.

“South Florida and the San Francisco Bay Area are high priority regions for ending the HIV epidemic where more comprehensive approaches are needed to meet the unique HIV prevention needs of sexual minority men who use stimulants,” said Dr. Carrico. “Our team hopes to identify a scalable, evidence-based intervention to assist this high priority population with maximizing the prevention effectiveness of daily oral PrEP.”

Dr. Carrico and Dr. Johnson will test the efficacy of an Affect Regulation Treatment to Enhance Medication Intervention Success (ARTEMIS) positive affect intervention. The ARTEMIS positive affect intervention will be delivered during three months of contingency management where participants receive tangible incentives for directly observed PrEP doses that are recorded using their smartphones.

The scientific premise is that delivering the ARTEMIS positive affect intervention during contingency management will assist men with achieving more durable improvements in PrEP adherence over 12 months, which will be confirmed using dried blood spots to measure PrEP medication levels.

Recently, Dr. Carrico and his team have demonstrated that the ARTEMIS positive affect intervention delivered during contingency management for stimulant abstinence achieves long-lasting and clinically meaningful reductions in viral load among sexual minority men living with HIV who use methamphetamine. Findings from his team and others have also demonstrated that stimulant use is a key obstacle to PrEP adherence and persistence in sexual minority men. 

“We are excited to have this opportunity to test the promising ARTEMIS positive affect intervention model our team has pioneered for sexual minority men who use stimulants,” said Dr. Carrico. “Identifying evidence-based approaches to improve PrEP adherence in this population represents an important first step towards reducing HIV incidence in high priority regions for ending the HIV epidemic.”

This project builds on the collaborations of Dr. Carrico and Dr. Johnson that span over a decade. Dr. Johnson was one of Dr. Carrico’s primary mentors during his postdoctoral fellowship in Health Psychology at UCSF. Dr. Johnson also continued to serve as a career mentor while Dr. Carrico was a junior faculty member at the UCSF Center for AIDS Prevention Studies and School of Nursing.

“I am thrilled to partner with Dr. Carrico on this important project that addresses the HIV prevention challenges of a key population at risk of being left behind by current efforts to end the HIV epidemic,” said Dr. Johnson. “The work also offers the rich opportunity to deepen the collaborative relationship between UCSF and the University of Miami.”

Written by Amanda Torres
Published on July 29, 2020