Address Substance

• A majority of trans women who initiate PrEP do not achieve protective adherence level, (Deutsch et al., 2015) and similar outcomes are observed among high-risk SMM (Hosek et al., 2017, Molina et al., 2015). [...] • Substance use, especially stimulant use, interferes with PrEP initiation among SMM, (Biello et al., 2017) and has repeatedly been shown to reduce rates of PrEP adherence and/or persistence among both trans women and SMM (Hoenigl et al., 2018, Goodman-Meza et al., 2019). [...] To improve public health, researchers must identify scalable and cost-effective behavioral interventions to promote PrEP initiation, adherence, and persistence among trans women and SMM with a SUD. [...] Study Aims Evaluate a Stepped Care approach promoting advancement along the PrEP Care Continuum (initiation, adherence, persistence), and reductions in substance use among trans women and SMM with a SUD. [...] Estimate the cost of implementing and sustaining each intervention (Stepped Care with: a] A.S. [...] K.-PrEP arm and 24 into the Standard of Care (SOC) arm • 58/70 (83%) of those randomized to A.S. [...] PrEP Linkage & Initiation PrEP linkage has been strong with 83% in the A.S.K.-PrEP arm linked to a PrEP provider. [...] PrEP initiation has been greater among those in the A.S. [...] The “safe sex” conundrum: anticipated stigma from sexual partners as a barrier to PrEP use among substance using MSM engaging in transactional sex. AIDS and Behavior. [...] Substance use and adherence to HIV preexposure prophylaxis for men who have sex with men.