ASK-PrEP (Assistance Services Knowledge-PrEP)

NCT ID: NCT05934877

Last Updated: 2025-07-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

152 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-05-11

Study Completion Date

2026-07-30

Brief Summary

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ASK-PrEP is a two-arm randomized controlled trial (RCT), with a Stepped Care approach, among HIV-negative trans women and men who have sex with men with a substance use disorder (SUD). Participants will be randomized (3:1) to the ASK-PrEP Stepped Care arm or Standard of Care (SOC). Participants in the ASK-PrEP Stepped Care arm will receive 5 PrEP navigation sessions, with weekly text-messaging support, delivered over 3 months, at which point they will be assessed for intervention response. Responders will be maintained for an additional 3 months in ASK-PrEP to receive an additional 5 PrEP navigation session with weekly text-messaging support, while non-responders will receive added attention to their SUD via contingency management (CM). Non-responders will be re-randomized (1:1) to either a) receive ASK-PrEP + CM, or b) shift the primary focus to their SUD (CM alone) for an additional 3 months.

Detailed Description

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ASK-PrEP is a two-arm randomized controlled trial (RCT), with a Stepped Care approach, to determine the optimal (considering effectiveness and cost-effectiveness) intervention, or combined interventions for advancement along the PrEP Care Continuum, and reductions in substance use among HIV-negative trans women (TW) and men who have sex with me (MSM), with a substance use disorder (SUD; N=250). After screening, informed consent, and baseline assessment, participants will be randomized (3:1) into one of two arms: ASK-PrEP Stepped Care or Standard of Care (SOC) control. At 3-month follow-up assessments, responders will be maintained in ASK-PrEP for an additional 3 months; non-responders will be stepped up and re-randomized (1:1) to either ASK-PrEP+CM or CM alone. Thus, non-responders will receive added attention to their SUD via CM; i.e., non-responders will either: a) receive CM in addition to a continued focus on PrEP adherence and other behavioral health issues (ASK-PrEP+CM), or b) shift the primary attention to their SUD (CM alone). Participants may choose to initiate daily oral PrEP (Truvada or Descovy) or long-acting injectable Cabotegravir. The 3-month step criteria are based on: 1) PrEP initiation and adherence; 2) substance use; and 3) HIV sexual risk behaviors if the participant has not initiated PrEP. The study uses repeated assessments at baseline and at 3-, 6-, 9-, and 12-months post-enrollment, via an "intent-to-treat" design, where all assessments are administered to participants regardless of their engagement or retention. All intervention content is tailored to TW/MSM with a SUD.

ASK-PrEP is a PrEP navigation intervention with text-messaging support. The navigation component is based on mechanisms of the Reasoned Action Approach (RAA), and the text-messaging support component is based on Social Support Theory (SST). In Session 1, the PrEP navigator uses the Needs and Barriers Assessment (NBA) to identify needs and barriers to PrEP care, including substance use and behavioral health needs; adherence goal(s); and methods to achieve adherence. PrEP (Truvada, Descovy, Cabotegravir) and clinic options are discussed. Per current state-of-the-field recommendations, participants are guided to receive same-day PrEP linkage to their chosen clinic, with the goal of PrEP initiation within the first week of enrollment. In Sessions 2-5, PrEP navigators use the information from the NBA to help the participant overcome barriers to PrEP adherence, and work with participants to address their SUD and need for additional auxiliary services. A shorter version of the NBA (NBA-Lite) is administered at the beginning of Sessions 2-5 as a check-in, and to assess progress through the PrEP Care Continuum; client-centered treatment plans are reviewed and revised as needed. In the ASK-PrEP sessions, client-centered dialogical strategies premised on RAA: 1) identify barriers to PrEP, including substance use; 2) identify participants' readiness to address their SUD and link into other auxiliary needed services; and 3) increase participants' skills and self-efficacy in working with PrEP providers and other social service and treatment facilities. Using a client-centered approach, the PrEP navigator works to link participants into SUD treatment and other ancillary behavioral health and support services, according to their unique barriers, with the ultimate goal of PrEP initiation, adherence, and persistence; services may include mental healthcare, counseling for intimate partner violence, food insecurity, housing instability, hormone therapy. Discussions of PrEP adherence, reductions in substance use and/or substance use treatment, and other behavioral health concerns are discussed throughout the 5 sessions. A key feature of the study is the tailoring of PrEP navigation and text-messaging support to TW/MSM with a SUD.

The text-messaging support component of ASK-PrEP is based in SST. One PrEP support text message is transmitted weekly on Wednesday afternoon between 3:00 - 6:00, participants may choose to have the text messages delivered via cell phone or email. To maintain interest and enthusiasm for the intervention, participants receive TW- or MSM-specific messages, and never receive the same message twice.

Contingency Management is based on behavioral economics. Non-responders are stepped and re-randomized to CM, either in concert with ASK-PrEP, or alone. At the first CM session, a RA provides a 15-minute orientation to the CM procedures, which includes an explanation of the progressive contingency schedule. Thereafter, participants meet with the RA thrice weekly to provide a urine sample. Participants receive a voucher-based escalating reinforcement schedule. Successive urine samples that are nonreactive for the metabolites of their identified SUD will escalate their voucher point value. Each three consecutive nonreactive urine samples will receive bonus voucher points. A reactive urine sample will place the participant at the initial voucher point value; however, a rapid reset procedure allows participants to return to their place in the escalating schedule following three consecutive nonreactive urine samples. Voucher points can be redeemed at any time during the study for goods or services that promote a pro-social and healthy lifestyle.

Participants stepped and re-randomized into ASK-PrEP+CM receive the same ASK-PrEP and CM interventions (described above), but in concert to increase intensity and address both SUD and PrEP initiation, adherence and persistence.

The Standard of Care (SOC) arm provides PrEP education, information, and referrals. Those randomized to the SOC arm will receive an approximate 20-30-minute educational session on PrEP, and will be given a PrEP pamphlet and list of clinics that provide PrEP in Los Angeles County (LAC). The same educational session will be repeated following the 3-month follow-up assessment visit.

Conditions

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Substance Use Disorders HIV

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

Two randomly assigned arms (3:1) into ASK-PrEP Stepped Care (PrEP navigation) or Standard of Care (SOC).
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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ASK-PrEP

ASK-PrEP is a 5-session PrEP navigation intervention, with text-messaging support, to advance through the PrEP Care Continuum by identifying the individual needs and barriers to PrEP care, including substance use and behavioral health needs; adherence goal(s); and methods to achieve adherence.

Intervention/treatment: PrEP navigation + text messaging Participants receive 5 PrEP navigation sessions within 3 months plus a weekly culturally specific, scripted text message. Participants that do not respond to the ASK-PrEP intervention at the 3-month assessment are re-randomized (1:1) and stepped up to receive ASK-PrEP plus CM or CM alone.

Group Type EXPERIMENTAL

PrEP navigation + text messaging

Intervention Type BEHAVIORAL

Using a client-centered approach, the PrEP navigator works to link participants into SUD treatment and other ancillary behavioral health and support services, according to their unique barriers, with the ultimate goal of PrEP initiation, adherence, and persistence; services may include mental healthcare, counseling for intimate partner violence, food insecurity, housing instability, hormone therapy. Text-messaging support includes once weekly text message.

Contingency Management

Intervention Type BEHAVIORAL

Non-responders in the ASK-PrEP arm will be stepped and re-randomized (1:1) to Contingency Management (CM), either in concert with ASK-PrEP or alone. CM is a progressive contingency schedule. Participants submit a thrice weekly urine sample. Participants will receive a voucher-based escalating reinforcement schedule. Successive urine samples that are nonreactive for the metabolites of their identified SUD will escalate their voucher point value. Each three consecutive nonreactive urine samples will receive bonus voucher points. A reactive urine sample will place the participant at the initial voucher point value; however, a rapid reset procedure allows participants to return to their place in the escalating schedule following three consecutive nonreactive urine samples. Voucher points can be redeemed at any time during the study for goods or services that promote a pro-social and healthy lifestyle.

Education and Information

The Standard of Care (SOC) intervention includes a 20-30-minute session of PrEP information and where to access PrEP in Los Angeles. The same session is repeated at the 3-month assessment.

Participants randomized to the SOC arm receive 2 educational/informational sessions on PrEP misconceptions, uptake, and adherence. The sessions occur at baseline and the 3-month assessment.

Group Type EXPERIMENTAL

Standard of Care

Intervention Type BEHAVIORAL

The SOC arm provides PrEP education, information, and referrals. Those randomized to the SOC arm receive an approximate 20-30-minute educational session on PrEP, and will be given a PrEP pamphlet and list of clinics that provide PrEP in LAC.

Interventions

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PrEP navigation + text messaging

Using a client-centered approach, the PrEP navigator works to link participants into SUD treatment and other ancillary behavioral health and support services, according to their unique barriers, with the ultimate goal of PrEP initiation, adherence, and persistence; services may include mental healthcare, counseling for intimate partner violence, food insecurity, housing instability, hormone therapy. Text-messaging support includes once weekly text message.

Intervention Type BEHAVIORAL

Standard of Care

The SOC arm provides PrEP education, information, and referrals. Those randomized to the SOC arm receive an approximate 20-30-minute educational session on PrEP, and will be given a PrEP pamphlet and list of clinics that provide PrEP in LAC.

Intervention Type BEHAVIORAL

Contingency Management

Non-responders in the ASK-PrEP arm will be stepped and re-randomized (1:1) to Contingency Management (CM), either in concert with ASK-PrEP or alone. CM is a progressive contingency schedule. Participants submit a thrice weekly urine sample. Participants will receive a voucher-based escalating reinforcement schedule. Successive urine samples that are nonreactive for the metabolites of their identified SUD will escalate their voucher point value. Each three consecutive nonreactive urine samples will receive bonus voucher points. A reactive urine sample will place the participant at the initial voucher point value; however, a rapid reset procedure allows participants to return to their place in the escalating schedule following three consecutive nonreactive urine samples. Voucher points can be redeemed at any time during the study for goods or services that promote a pro-social and healthy lifestyle.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* self-identified transgender woman or MSM
* ≥18 years old
* verified HIV negative
* identified as high risk for HIV based on the Los Angeles County criteria
* SUD (injection and non-injection; excluding cannabis (CUD) only

For those who have already initiated PrEP there is an additional eligibility criterion:

* non-protective prophylaxis defined as missed ≥4 doses of PrEP/week during any week in the previous 30 days
* no PrEP care visits in the past 3 months
* willing to provide informed consent; and
* willing to comply with study requirements.

Should a participant be identified as having kidney or liver dysfunction sufficient to contraindicate PrEP use (creatinine clearance \<60 mL/min), that individual will be withdrawn from study participation but may re-screen for eligibility once adequate renal and/or liver function has been established and medically documented (≥60 mL/min).

Exclusion Criteria

* does not identify as a trans woman or male who has sex with men
* under 18 years of age
* HIV positive status
* not identified as high risk for HIV based on the Los Angeles County criteria
* no verified SUD or only CUD
* if already initiated PrEP: PrEP adherent and PrEP care visits in the past 3 months
* unwilling to provide informed consent
* unwilling to comply with study requirements;
Minimum Eligible Age

18 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Weill Medical College of Cornell University

OTHER

Sponsor Role collaborator

University of California, Los Angeles

OTHER

Sponsor Role collaborator

Emory University

OTHER

Sponsor Role collaborator

Friends Research Institute, Inc.

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Cathy J Reback, PhD

Role: PRINCIPAL_INVESTIGATOR

Friends Research Institute, Inc.

Sean M Murphy, PhD

Role: PRINCIPAL_INVESTIGATOR

Weill Medical College of Cornell University

Locations

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Friends Community Center

Los Angeles, California, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Cathy J Reback, PhD

Role: CONTACT

323-463-1601

Sean M Murphy, PhD

Role: CONTACT

646-962-9710

Facility Contacts

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Ray P Mata

Role: primary

323-493-6824

Michael J Li, PhD

Role: backup

310-794-8530

References

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Reback CJ, Landovitz RJ, Benkeser D, Jalali A, Shoptaw S, Li MJ, Mata RP, Ryan D, Jeng PJ, Murphy SM. Protocol for a randomized controlled trial with a stepped care approach, utilizing PrEP navigation with and without contingency management, for transgender women and sexual minority men with a substance use disorder: Assistance Services Knowledge-PrEP (A.S.K.-PrEP). Addict Sci Clin Pract. 2024 Nov 9;19(1):79. doi: 10.1186/s13722-024-00482-6.

Reference Type DERIVED
PMID: 39521970 (View on PubMed)

Other Identifiers

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R01DA056888

Identifier Type: NIH

Identifier Source: org_study_id

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