Background: Peer-driven strategies leveraging existing online social networks may be an effective approach to engage young Black/Latinx men who have sex with men (YBLMSM) for HIV prevention. We developed and tested the feasibility, acceptability, and preliminary impact of a theory-based, online intervention addressing barriers to PrEP adoption in a cluster randomized control trial.
Methods: ePrEP was a six-week online campaign addressing PrEP barriers, developed and delivered by YBLMSM Influential Peers (IPs) via private Facebook/Instagram groups to their existing online-social-networks (e.g., friends/followers) in New York City. We recruited and randomized 10 IPs to ePrEP (n=5) or an attention-matched control (n=5). IPs then recruited YBLMSM participants (aged 18-29, Black or Latinx, New York City resident, HIV-uninfected, at high-risk) from their online networks to a private online Facebook/Instagram group. IPs then posted condition specific contents to their respective groups and facilitated discussions about the contents. Outcomes included retention, acceptability, and PrEP related-knowledge, -communication skills,-stigma, and -use collected through online surveys (baseline, 6- and 12-weeks).
Results: Over three weeks from May-June 2017, IPs recruited 423 YBLGBM; 155 screened eligible and were enrolled (ePrEP [n=83] and control [n=72]). Baseline characteristics were similar across groups and 18% were on PrEP. At 12-weeks, >90% of participants were retained in both arms, 82% would continue participating, 78% reported high satisfaction, and 75% would recommend friends to participate. Engagement with online campaign posts was also similar in both arms (p=0.7). At 12-weeks, ePrEP participants compared to control, showed greater increases in knowledge (p=0.02), communication skills about PrEP use (p=0.06), and decreases in PrEP-stigma (p=0.06). Among those not on PrEP at baseline, there was a trend towards more new PrEP initiations in ePrEP (5/52) vs. Control (3/52) (p=0.2) at 6-weeks, but similar by 12-weeks (6 vs. 5).
Conclusions: A peer-developed and delivered online social-network intervention was highly feasible, acceptable, and efficient in engaging YBLGBM at high-risk of HIV-infection for a PrEP-uptake intervention, and may have utility for incorporation into programs to enhance PrEP uptake, adherence, and maintenance.