# Parrying the Pitfalls of PrEP: Preventing Premature PrEP Discontinuation and STIs among Young Black MSM

> **NIH NIH R01** · EMORY UNIVERSITY · 2022 · $749,972

## Abstract

Abstract
Young (aged 18-29) Black men who have sex with men (YBMSM) in Atlanta experience high rates of HIV
acquisition (8.9%/year) and STI infection (30%/year). Over the past 5 years, we have followed a cohort of 300
YBMSM in Atlanta and have offered PrEP as part of a comprehensive package of prevention interventions.
We have had substantial uptake of PrEP – over 40% of YBMSM initiated PrEP – but we have also observed
high rates of PrEP discontinuation (39% of all PrEP starts) and ongoing high rates of new STI diagnoses.
Even with 44% PrEP uptake in the cohort, HIV incidence remained high at 6.2%/year. This represents a 30%
reduction in HIV incidence compared to our pre-PrEP comparison cohort, but is still unacceptably high.
Therefore, we proposed to continue our cohort approach but to add three new interventions: (1) an innovative
“early warning” system to identify YBMSM on PrEP who are at risk for discontinuing PrEP, and providing a
motivational interviewing-based peer intervention; (2) offering on-demand PrEP to men who decline daily PrEP
or who plan to stop daily PrEP because they are unwilling to take a daily pill or perceive their risks to be
infrequent; and (3) offering STI PEP with doxycycline for all men, regardless of PrEP use, to avert new STIs.
This is an implementation-focused, single arm cohort approach, using a target trial design to emulate a
randomized trial and evaluation of process measures. Primary outcomes are rates of PrEP discontinuation
and rates of new STI diagnoses.

## Key facts

- **NIH application ID:** 10399433
- **Project number:** 5R01MH122341-03
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Colleen F Kelley
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $749,972
- **Award type:** 5
- **Project period:** 2020-04-01 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10399433

## Citation

> US National Institutes of Health, RePORTER application 10399433, Parrying the Pitfalls of PrEP: Preventing Premature PrEP Discontinuation and STIs among Young Black MSM (5R01MH122341-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10399433. Licensed CC0.

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