The eleccion cohort: developing and testing a scalable, platform agnostic digital intervention

The National Institute of Allergy and Infectious Diseases awarded Emory University a $2.148 million cooperative agreement on June 16, 2026, under the Allergy and Infectious Diseases Research program (CFDA 93.855) to design and evaluate an mHealth HIV-prevention intervention delivered to men who have sex with men (MSM) in Peru using WhatsApp.

The research, titled "The Eleccion Cohort: Developing and Testing a Scalable, Platform Agnostic Digital Intervention," addresses low uptake of HIV pre-exposure prophylaxis (PrEP) in Peru, where awareness and utilization remain critically constrained by stigma and structural barriers despite high HIV prevalence and incidence among MSM. As of September 2023, only 0.9 percent of an estimated 90,000 potentially eligible persons in Peru were receiving PrEP. The intervention leverages WhatsApp, a platform previously identified by MSM as a preferred channel for sexual health information, and exploits Peru's high smartphone penetration (88 percent of households in 2022). The study will enroll a cohort to examine HIV transmission networks and prevention outcomes, with findings intended to inform prevention efforts in both Peru and the United States.

Place of performance is Atlanta, Georgia. The period of performance runs through May 31, 2028. The source does not identify sub-recipients or pass-through funding.

Abstract

The proposed study cannot feasibly be conducted in the united states for three reasons: (1) the grant request for applications required the grants to be located in latin america, (2) the study will shed light on HIV transmission networks and prevention in peru, with findings that will inform future efforts in peru and the united states, and (3) the costs of conducting an identically designed study in the US would be many fold higher than the proposed budget, making IT infeasible to develop the same scientific knowledge base with available funds. We note that despite the availability of free HIV antiretroviral therapy in latin america, this region has continued to experience substantial HIV incidence; IT is one of the only world regions to have increasing rather than decreasing HIV incidence. In peru, the HIV epidemic is concentrated among men who have SEX with men (MSM), in whom HIV prevalence and incidence are high (prevalence ~10%, and annualized incidence ~5-6%). Access to HIV prevention services has been hindered by stigma and structural barriers. This likely contributes to low uptake of HIV testing and limited condom use among populations at risk. Access to HIV pre-exposure prophylaxis (prep) has historically been limited. Prep awareness and uptake are low, with 0.9% of the estimated 90,000 potentially eligible persons receiving IT as of september, 2023. With the goal of increasing use of prevention services, the proposed research will design and evaluate an mhealth HIV-prevention intervention delivered to MSM using whatsapp, a ubiquitous platform previously identified by MSM as a preferred channel for receipt of information about prep and other sexual health services. An mhealth intervention is appropriate in peru as IT has high penetration of smart phones: 88% of households had a smartphone in 2022. This study will enroll a cohort to study predictors of HIV incidence and to adapt an evidence-based mhealth intervention to the peruvian context. The primary study population will be a cohort of MSM from high-incidence populations but without HIV and 500+ plwa who will be followed remotely via whatsapp and secure electronic surveys to assess the following aims. Aim 1. Cohort development: build digital cohort of 5,500 MSM in peru (500 plwh, 5,000 HIV negative). In the first 18 months of follow-up, monitor HIV incidence using HIV self-tests and assess predictors of HIV prevention and treatment cascades. MSM with HIV will be followed for linkage to HIV care, retention and VL suppression using data from the peruvian national HIV program. (UG3 phase, years 0-2). Aim 2. Leverage cohort data to inform HIV interventions in peru: aim 2.1. Using adapt-ITT, adapt an existing digital HIV-prevention intervention (m-cubed) to whatsapp and secure surveys to provide information and services to persons without access to public mail service (UG3 phase, years 0-2). Aim 2.2. Determine intervention preferences for the adapted intervention and for future interventions through a series of discrete choice experiments. (UH3 phases, years 0-5). Aim 3. Conduct a randomized trial of the low-touch intervention: the adapted m-cubicado digital choice intervention will be assessed in months 18-30 of follow-up by randomizing ~3960 HIV negative participants 1:1 to the digital intervention or the standard care control with a primary outcome of having received a prep prescription (UH3 phase, years 3-5). This study will produce health benefits for united states citizens in several ways. First, the sexual HIV transmission route to be studied in peru is also the predominant transmission route in the united states, so findings regarding transmission networks and how to intervene will likely be portable to united states settings. Second, the intervention we will test will be a digital, low-touch intervention that expands upon our prior research in the united states by creating and testing a more scalable version. We anticipate that the more