Developing status-neutral approaches to increase uptake of long acting injectable prep and art among black and latinx men with less than optimal adherence in southern california

The National Institute of Mental Health awarded the University of California, San Diego $441,215 on July 15, 2026, under the Mental Health Research Grants program (CFDA 93.242) to explore barriers and facilitators of HIV care and prevention service engagement among 18–45-year-old Black and Latinx sexual minority men in San Diego, San Bernardino, and Riverside Counties, California.

The project investigates new intervention approaches to increase uptake and persistence of long-acting injectable pre-exposure prophylaxis (LAI-PREP) and long-acting injectable antiretroviral treatment (LAI-ART) among individuals with suboptimal care engagement, inadequate oral PREP or ART adherence, or unknown or detectable viral load. The research adopts the CDC's status-neutral approach to examine how socio-structural inequities affect LAI adoption in populations bearing a disproportionate burden of HIV diagnoses. Long-acting formulations address known barriers to oral adherence, including substance use, depression, and lack of safe storage space for pill bottles.

UC San Diego, located in La Jolla, California, serves as the recipient and primary research institution. The award carries a performance period from July 15, 2026, through July 14, 2028. This is a Project Grant, the standard assistance type for investigator-initiated research under NIMH's portfolio.

Abstract

The proposed project will explore barriers and facilitators of HIV care and prevention service engagement and new intervention approaches to increase long-acting antiretroviral treatment (LAI-art) and pre exposure prophylaxis (LAI-prep) uptake and persistence among 18-45-year-old black and latinx sexual minority men (b/lsmm) in SAN diego, SAN bernardino, and riverside counties, california, three EHE jurisdictions. This research will focus on b/lsmm with suboptimal care engagement, prep/art adherence, or unknown or detectable viral load. Black and latinx SMM bear a disproportionate burden of HIV in the US, accounting for 38% and 32% of new diagnoses among SMM, respectively. Prep uptake is lower among b/lsmm than white SMM in california, and b/lsmm living with HIV (b/lsmm+) have lower overall art adherence, and viral suppression. Of the 61 health jurisdictions in california, SAN bernardino and SAN diego counties rank 46TH and 48TH in viral suppression rates and, in 2020, most black (54%) and latinx (52%) people with HIV (PWH) in riverside county had received an aids diagnosis. Long-acting injectable forms of prep (LAI-prep) and art (LAI-art) have the potential to overcome some known barriers to oral prep and art adherence such as missing daily prep and art doses due to substance use or depression or lacking a safe and private place to store pill bottles. To date, little is known about the barriers and facilitators of LAI uptake among b/lsmm. For the proposed study we will adopt the CDC's status neutral approach to elucidate the impact of these socio-structural inequities on LAI-prep and LAI-art uptake. New strategies are needed to increase uptake of lais among those who can most benefit, such as b/lsmm with less than adequate care engagement and oral art and prep adherence. Guided by intersectionality, syndemics theory, and the health equity implementation framework, this project has two aims. AIM1: qualitatively explore knowledge, attitudes, and perceived barriers and facilitators of LAI-prep and LAI-art uptake and identify acceptable and appropriate approaches to increase uptake among b/lsmm who report less than optimal oral prep/art adherence. We will conduct 30 in-depth qualitative interviews with b/lsmm, evenly stratified by race and HIV status, and three focus groups (one in each EHE priority county) with staff and clinicians from community-based organizations serving b/lsmm. AIM2: quantitatively assess knowledge, barriers, and facilitators of LAI-prep and LAI-art uptake among b/lsmm and assess interest and acceptability of potential intervention approaches.