Participatory System Dynamics to Enhance PrEP Access for Black and Latinx Sexual Minority Men in Bronx, NY

ABSTRACT Black and Latinx sexual minority men (BLSMM) in the Bronx, NY and in the U.S. overall are among the populations most impacted by HIV in both Bronx, NY and in the U.S. BLSMM are impacted by multiplel barriers, including medical mistrust, multiple stigmas, and limited health care access, which intersect to

cumulatively increase HIV risk and negatively impact access to pre-exposure prophylaxis (PrEP). Improving access to and use of PrEP requires care delivery strategies tailored to the unique needs and circumstances of BLSMM. There is broad consensus that addressing disparities impacting BLSMM and ending the HIV epidemic

requires creative, community-engaged, participatory approaches. One such approach is system dynamics modeling, an action research methodology to identify practicable, effective solutions to complex problems by examining both the dynamic relationships between their underlying factors and the potential impact of

interventions to address these problems. In the proposed study, together with a diverse, Bronx-based group of community and implementer stakeholders, we will undertake a system dynamics-informed implementation mapping process to identify promising PrEP implementation strategies. This work will be guided by two

implementation science frameworks: the Consolidated Framework for Implementation Research (CFIR) and Proctor’s Taxonomy of Implementation Outcomes. In the R21 phase of this proposal, we aim to: (1) co-design and validate a system dynamics model delineating factors influencing PrEP engagement for BLSMM, and (2)

use the resultant model to determine the potential effectiveness of one or more prioritized strategies to improve PrEP engagement. If we achieve pre-specified R21 milestones, in the R33 phase, our specific aim is to: (3) pilot test the most promising strategies, working with stakeholders to operationalize and implement the

strategies and measure their impact. The findings from this participatory, community-engaged study will provide timely and practical data that will advance our understanding of how to reduce disparities in PrEP uptake and ultimately HIV transmission rates for BLSMM.