# Adaptive intervention strategies to optimize PrEP clinical evaluation and uptake in stimulant-using men

> **NIH NIH R34** · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · 2020 · $231,198

## Abstract

ABSTRACT
Among men who have sex with men (MSM), there is an urgent need to optimize the unprecedented clinical
and public health benefits of pre-exposure prophylaxis (PrEP) with those who use stimulants (i.e.,
methamphetamine, cocaine, and crack-cocaine). Stimulant-using MSM experience substantial difficulties with
navigating HIV prevention services such that this population currently accounts for one-in-ten undiagnosed HIV
infections. The overarching goal of Positive Reinforcement Intervention and Sustained Motivation (PRISM) is to
adapt and pilot test scalable, evidence-based motivational enhancement interventions to optimize PrEP clinical
evaluation and PrEP uptake in stimulant-using MSM. PRISM will target PrEP clinical evaluation (including HIV
testing) as the primary outcome, which will have a dual benefit of facilitating entry of those who are HIV-
negative into the PrEP care continuum and promoting regular HIV testing in this high priority population. In
Phase 1, we will collect qualitative data from members of PrEP healthcare teams (N = 10) and stimulant-using
MSM who are not on PrEP (N = 30) to inform enhancements to PRISM, which includes evidence-based
contingency management (CM) and motivational interviewing (MI) interventions that we have previously shown
to reduce substance use and condomless anal sex in MSM. We will focus on augmenting these motivational
enhancement interventions to simultaneously facilitate entry of into the PrEP care continuum. In Phase 2, we
will conduct a pilot sequential multiple assignment randomized trial (SMART) with 60 HIV-negative, stimulant-
using MSM with no history of PrEP use. After completing 1-week waiting period, participants will be
randomized to receive: 1) a 3-month CM intervention; or 2) four sessions of MI. All participants will be
assessed at three months post-randomization for non-response, defined as not having completed PrEP clinical
evaluation. Using SMART methods, in a second randomization non-responders will be assigned to: 1) Switch
by adding the other intervention (i.e., CM+MI or MI+CM); or 2) Continue with assessments (i.e., CM-Only or
MI-Only). Findings from the pilot SMART regarding the feasibility and acceptability of the interventions, the
estimated non-response rate, and cost of delivering the interventions will be reviewed with community-based
providers of HIV prevention services to lay the foundation for a full-scale SMART. Consistent with the NIH OAR
high priority area of “reducing the incidence of HIV/AIDS,” this clinical research will meaningfully inform the
targeted deployment of limited public health resources to optimize the unprecedented clinical and public health
benefits of PrEP in stimulant-using MSM, one of highest priority populations for decreasing HIV incidence.

## Key facts

- **NIH application ID:** 9872156
- **Project number:** 5R34DA046367-02
- **Recipient organization:** UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
- **Principal Investigator:** Adam Wayne Carrico
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $231,198
- **Award type:** 5
- **Project period:** 2019-02-15 → 2022-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9872156

## Citation

> US National Institutes of Health, RePORTER application 9872156, Adaptive intervention strategies to optimize PrEP clinical evaluation and uptake in stimulant-using men (5R34DA046367-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9872156. Licensed CC0.

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