# A Multi-Level Integrated Strategy to Optimize PrEP Adherence for Black MSM and Accelerate Implementation at Scale

> **NIH NIH R01** · YALE UNIVERSITY · 2024 · $709,213

## Abstract

PROJECT SUMMARY
Scalable interventions that facilitate adherence to HIV PrEP are urgently needed to address the
alarming HIV incidence in Black MSM. In 2020, only 26% of Black MSM in the U.S. used PrEP
even though they represented 40% of HIV diagnoses. There are multi-level barriers to PrEP
adherence among Black MSM, including interpersonal and institutional intersectional stigmas. To
optimize equity in PrEP coverage, Black MSM must have access to service options that reduce
their exposure to these stigmas. Many Men Many Voices (3MV) is a group-level behavioral
intervention that demonstrated efficacy for increasing healthcare seeking behaviors in Black
MSM. Client-centered care coordination (C4) addresses social stigma through a service model
that trains staff to deliver autonomy-supportive care and addresses structural stigma via an
integrated online platform to improve the continuity of coordination between service providers.
Our goal is to combine two evidence-based interventions into a multi-level integrated strategy that
directly addresses interpersonal stigma via 3MV, extends 3MV effects into service-delivery
settings by training staff on key concepts, and then addresses structural stigma by linking men to
a network of services via the online C4 platform. We will pursue the following aims with 2
implementing agencies serving Black MSM: (1) determine the efficacy of an integrated 3MV+ C4
for increasing PrEP adherence; (2) ascertain the optimal dose of C4 implementation for
maximizing its effect on PrEP adherence; (3) identify the critical leverage points in the
implementation ecosystem to target for change. 48 egocentric networks of Black MSM (N=480;
mean network size n=10) will be recruited in Dallas/Ft. Worth and Miami/Ft. Lauderdale. Networks
will all begin with a 3-month control phase and be randomized into either the C4 arm or the
C4+3MV arm. The Learn-as-you-go (LAGO) statistical methodology will be used to optimize the
strategy and associated costs by generating statistical recommendations for modifying pre-
specified components of C4. Qualitative interviews will explore the factors affecting
implementation at scale. Lastly, we will develop a policy brief accounting for the political economy
and non-economic welfare effects of 3MV+C4. This study advances HIV prevention science by
generating evidence for an intervention that will contribute to racial equity in the impact of PrEP
on the HIV epidemic. Our research also uses innovative statistical and interdisciplinary methods
that allow us to maximize 3MV and C4’s effects on adherence by: (1) optimizing elements
observed to be contributing to increases in adherence and (2) streamlining excess elements to
reduce implementation time and costs; thus, enhancing scale-up potential in EHE communities.

## Key facts

- **NIH application ID:** 11009836
- **Project number:** 1R01MH138225-01
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** LaRon Earnest Nelson
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $709,213
- **Award type:** 1
- **Project period:** 2024-09-06 → 2029-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11009836

## Citation

> US National Institutes of Health, RePORTER application 11009836, A Multi-Level Integrated Strategy to Optimize PrEP Adherence for Black MSM and Accelerate Implementation at Scale (1R01MH138225-01). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/11009836. Licensed CC0.

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