Using behavioral economics to improve the uptake of and persistence on pre-exposure prophylaxis in men who have sex with men to prevent HIV infection

NIH Pandemic-Era Grants

Pandemic Era Grants

2024

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Principal Investigator: Lawrence Camdon Long
Organization: BOSTON UNIVERSITY MEDICAL CAMPUS
Fiscal Year: 2024
Award: $172,595
Funding agency: National Institute of Mental Health

PROJECT SUMMARY / ABSTRACT
This is an application for a five-year K01 award for Dr. Lawrence Long, a Research Assistant Professor at
Boston University. The K01 award will support a complementary set of training activities and research aims
aimed at establishing Dr. Long as an independent researcher in the field of HIV prevention and behavioral
economics. This will allow Dr. Long to reach his long-term career goal of leading HIV research that guides the
design of health delivery programs (treatment and prevention) which encourages optimal health behavior and
decision making. The K01 will provide the support necessary to accomplish the following training goals: 1) to
obtain expert technical knowledge in the use of pre-exposure prophylaxis (PrEP) in men who have sex with
men; 2) to learn, master and apply the theory of human decision making; 3) to become skilled in the design
and implementation of behavior change interventions and 4) to successfully apply for independent research
funding. In order to achieve these training goals Dr. Long has proposed a career development plan centered
around strong mentorship supported by didactic training in behavioral economics, qualitative research
methods, and research approaches for working with vulnerable populations. Despite the largest HIV treatment
program in the world South Africa’s HIV incidence remains high, in particular amongst key populations such as
men who have sex with men (MSM). The recent inclusion of HIV pre-exposure prophylaxis (PrEP) as part of
the national prevention package in South Africa is considered key to reducing incidence in these populations,
yet pilot studies show sub optimal uptake and poor persistence amongst those most at risk. Dr. Long’s
research will focus on understanding why PrEP uptake and persistence amongst MSM in South Africa is low
and how the delivery of PrEP to this population could be altered to encourage those most at risk to start
treatment. The research will aim to: 1) identify predictors of PrEP initiation and persistence amongst South
African MSM testing negative at PREP pilot sites; 2) qualitatively examine the role of cognitive bias in the
decision to request, offer, accept and continue on PrEP from a health care provider and patient perspective;
and 3) develop and pilot a simple intervention to increase the uptake of and persistence on PrEP in MSM using
behavioral economic theory to improve decision making. In order to accomplish these aims Dr. Long has
access to the two pilot sites currently offering PrEP to MSM in South Africa. Before the completion of the K01
award Dr. Long will use this research as the basis for an R01 grant application which would aim to conduct a
randomized control trial to establish the effectiveness of behavioral economic interventions in improving PrEP
uptake amongst various key populations.

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