Evaluating Hierachal Text Messages for MSMs

Pre-Solicitation Notice for Solicitation 2012-N-14299 Project Title: "MAI Project to Evaluate Hierarchical Online and Text Messages for Black and Latino MSM" 1. Introduction. This is a Pre-solicitation Notice for a Full and Open Competition under North American Industry Classification System (NAICS) code 541720 "Research and Development in the Social Sciences and Humanities", with a small business size standard of $19 Million. When released the solicitation number will be 2012-N-14277. The solicitation Request for Proposal (RFP) will be made available on the Internet at http://www.fbo.gov on or about May 15, 2012. Request for Proposals will not be provided to interested parties in hard copy form. Telephone requests will not be honored. Interested parties are responsible for checking the website regularly for the release of the RFP and for other procurement-related documents. The information provided in this pre-solicitation is for information purposes only. If there are any differences in the information provided here and the actual solicitation, the information provided in the actual solicitation shall govern. 2. Overview: The Centers for Disease Control and Prevention (CDC), National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP), Division of HIV/AIDS Prevention (DHAP), Prevention Research Branch (PRB), is contemplating a single award two year for this project. 3. Purpose: The primary goal of this project is to demonstrate the effectiveness of hierarchical messages regarding multiple prevention options (via online and text messaging) in potentially reducing HIV transmission risk, and to determine the relative effectiveness of hierarchical messages compared to a single "condom only" message. Tailored messages will be tested for black and Latino MSM who are HIV-positive, high-risk HIV-negative (i.e., unprotected anal sex with a non-primary partner in the past 6 months), and low-risk HIV-negative (i.e., other MSM besides high-risk). A secondary goal is to determine whether specific hierarchical messages and "condom only" message effectiveness - and any differential main effects between message types (hierarchical vs. condom only) -- are moderated by race/ethnicity (i.e., black, Latino) and other demographic variables (e.g., geographical location, age group) for each of the three HIV-status groups. 4. Objectives: The primary goal of this project is to demonstrate the effectiveness of hierarchical messages regarding multiple prevention options in potentially reducing HIV transmission risk, and to determine the relative effectiveness of hierarchical messages compared to a single "condom only" message. ? 5. Background for the Acquisition. Black and Latino men who have sex with men (MSM) continue to have very high incidence of HIV infection in the United States - particularly black MSM (Prejean, 2011), and new approaches are needed to effectively reach and reduce HIV risk behavior of minority MSM. For 30 years, condoms have been the only effective physical intervention for reducing HIV infection risk, and thus the single "gold standard" message available to sexually-active MSM for protecting themselves and their partners. Recently, multiple biomedical intervention options have become available. Results have been presented for partial efficacy of pre-exposure chemoprophylaxis (PrEP) with anti-retroviral (ARV) medications (Grant 2010), and post-exposure prophylaxis (PEP) is already available in emergency situations. Although there are serious concerns about access to PrEP for many people, recent studies have found that minority (vs. white) MSM were more likely to use (by HIV-negative MSM) and share with sex partners (by HIV-positive MSM) non-prescribed PrEP and PEP several years before known efficacy (Mansergh 2010). Further, minority (vs. white) MSM were more willing to use a less efficacious PrEP product in order to avoid using condoms (Koblin 2011), and more willing to use PrEP even after PrEP efficacy results were known (Sullivan 2011). PrEP and PEP are likely to be prescribed only to HIV-negative MSM at highest risk for HIV transmission (by HIV-positives) and infection (by currently risky HIV-negatives). Even if PrEP access is not an issue, other biomedical interventions may not be too far in the future (e.g., topical ARV gels). Some studies (Marks 2010) have suggested that behavioral "seroadaptative" approaches may be an effective alternative for some - especially HIV-positive MSM. The relatively heightened willingness among some racial/ethnic minority MSM to use alternative products, and perhaps other HIV prevention intervention approaches, needs to be further understood. To help accomplish this, effective hierarchical messages should be developed for multiple prevention options of varying levels of effectiveness. Little research has been conducted on the effects of focused hierarchical messaging in HIV prevention beyond single messaging of condom use. However, a study of hierarchical (vs. male condom only) messages for young black and Latino women found that women who received the hierarchical message (i.e., use male condoms; if not use female condoms...) were less likely to report that male condoms were effective in reducing HIV infection (Miller 2004). Adding a second option to an existing established option can potentially impact perceptions about and intentions to use various prevention options in the future. Are there communication approaches to maximize HIV infection risk reduction in a world of multiple effective options? We are now entering an era of multiple prevention options (Shattock 2011) -- including PrEP, PEP, a topical ARV gel, or HIV seroadaptive behaviors (e.g., behavioral decisions based on viral load and anal sex position) -- and we need to prepare for disseminating simple and effective public health messages that clearly present these options. Differential hierarchical message options are likely to apply to HIV-positive, high-risk HIV-negative, and low-risk HIV-negative MSM. Implications of the findings of this study may apply to a variety of public health actions, from fact sheets to social marketing campaigns to federal guidelines, and may inform messaging within behavioral interventions currently implemented in communities of black and Latino MSM, as well as other populations. Lastly, text messaging has demonstrated promise as an intervention approach for high-risk MSM (Reback 2011), but is it differentially effective compared to online messaging of risk information? This proposal is aligned with the following NHAS goal and DHAP Strategic Plan as they relate to black and Latino MSM: Goal 1. Reducing New HIV Infections and related; Step 2. Expand targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches (2.1. Design and evaluate innovative prevention strategies and combination approaches for preventing HIV in high-risk communities; and 2.4. Expand prevention with HIV-positive individuals.). References: 1. Cohen MS, Chen YQ, McCauley M, et al. (2011). Prevention of HIV-1 infection with early antiretroviral therapy. NEJM, 365(6):493-505. 2. Ray M, Logan R, Sterne JA, et al. (2010). The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals. AIDS, 24:123-37. 3. Palella FJ, Chmiel JS, Moorman AC, Holmberg SD. (2002). Durability and predictors of success of highly active antiretroviral therapy for ambulatory HIV-infected patients. AIDS, 16, 1617-1626. 4. Gardner EM, McLees MP, Steiner JF, et al. (2011). The Spectrum of Engagement in HIV Care and its Relevance to Test-and-Treat Strategies for Prevention of HIV Infection. Clin Infect Dis, 52(6):793-800. 5. CDC. Vital Signs: HIV Prevention Through Care and Treatment - United States. MMWR 2011 (Early Release);60:1-6.CDC. 6. High-Impact HIV Prevention, CDC's Approach to Reducing HIV Infections in the United States. www.cdc.gov/HIV. August 2011. 7. Warner L, Klausner JD, Rietmeijer CA, et al. (2008). Effect of a Brief Video Intervention on Incident Infection among patients Attending Sexually Transmitted Disease Clinics. PLoS Medicine, 5(6)919-927.