# Using EMA to developmentally tailor an intervention to support on-demand PrEP among YMSM

> **NIH NIH R21** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2020 · $286,656

## Abstract

Project Abstract
Adolescent and young adult men who have sex with men (YMSM) bear a heavy burden of HIV in the United
States (US). Despite the availability of highly effective daily oral HIV pre-exposure prophylaxis (PrEP), uptake
and adherence to PrEP among YMSM remains low. The challenge of taking a daily pill, as well as concerns
regarding side effects of the medication, have been identified as reasons for lower than expected uptake of
PrEP among youth, and particularly YMSM of color. On-demand, or event-driven, PrEP has been shown to be
effective among adult MSM but, to date, has not been examined among YMSM. Data from the extant literature
support that YMSM with and without experience with PrEP show interest in exploring different dosing
strategies. This interest may translate into greater uptake of PrEP, particularly among those who have
expressed unwillingness to try a daily regimen or have not been successful adhering to a daily regimen. While
preliminary evidence from adolescent treatment studies suggests that intermittent regimens may be feasible for
youth, their ongoing executive function development, coupled with heightened responsiveness to
socioemotional contexts, has implications for decision making around sexual behavior and preventative health
care. In addition, traits common in adolescents – including impulsivity and sensation seeking - have
demonstrated significant and meaningful associations with behaviors that place YMSM at risk for HIV. For
these reasons, variable “on demand” strategies may be challenging for youth who are still developing
cognitively, and, require developmentally appropriate interventions to maximize their success. While studies of
on-demand PrEP strategies have shown that adult MSM have difficulties accurately predicting when sex will
occur, this has not been explored among YMSM. The proposed study fills these important gaps in
understanding to guide future on-demand PrEP interventions with YMSM. This study will provide insights into
potential developmental barriers to on-demand PrEP among YMSM and lay the groundwork for an innovative
intervention approach to address them through the completion of three specific aims. Specific Aims 1 and 2 will
provide a greater understanding of developmental and cognitive facilitators and barriers to on-demand PrEP.
To accomplish these aims, a sample of 120 youth (age 16-24 years) will be recruited and complete a daily
electronic diary for 8 weeks to record their predictions of, and actual engagement in, sexual encounters.
Surveys conducted at baseline and study completion will measure developmental and sociocultural factors
likely to impact prediction of risk (e.g. executive function, impulsivity, planning), and potential intervention
approaches (e.g. gist vs. verbatim messages, reward sensitivity). Focus groups conducted in Aim 3 will help to
translate findings from Aims 1 and 2 into a just-in-time intervention to increase YMSM's ability to plan for
sexual activity and ...

## Key facts

- **NIH application ID:** 10094161
- **Project number:** 1R21MH124678-01
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Lisa B Hightow-Weidman
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $286,656
- **Award type:** 1
- **Project period:** 2020-09-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10094161

## Citation

> US National Institutes of Health, RePORTER application 10094161, Using EMA to developmentally tailor an intervention to support on-demand PrEP among YMSM (1R21MH124678-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10094161. Licensed CC0.

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