Community-engaged adaptation and pilot testing of a mental health and substance use screening and referral process in HIV pre-exposure prophylaxis (PrEP) care in the Southern USA

Mental health and substance use concerns are prevalent in HIV pre-exposure prophylaxis (PrEP)-seeking and priority populations (e.g., same gender loving black men (SGLBM)), often negatively affecting health care outcomes. Identifying individuals who could benefit from access to effective behavioral health treatment remains suboptimal among these populations. We utilized a community-informed process to adapt an evidence-based behavioral health identification and linkage model, Screening Brief Intervention and Referral to Treatment (SBIRT), to include mental health screening and increase cultural responsiveness for use in PrEP care. We piloted the adapted SBIRT model (SBIRT PrEP) in a PrEP clinic in the U.S. South that serves primarily SGLBM. A total of 29 SGLBM participated in the pilot, which involved answering screening questions about anxiety, depression, alcohol, and drug use on an iPad. Participants met with a PrEP navigator to review screening results using a guided model that incorporated participant self-determination and motivational interviewing techniques. SGLBM and staff completed surveys and qualitative interviews that assessed their perceptions of the program. Study findings indicated that the adapted SBIRT PrEP model was acceptable and valued by clinic clients and staff. Survey and interview responses indicated that most clients believed that: 1) substance use and mental health screening was appropriate and important to include in PrEP services; 2) the program was an effective way to address mental health and substance use concerns; and 3) the duration of the screening process was acceptable. A majority of clients reported feeling comfortable answering behavior health screening questions on the iPad and discussing the results with the PrEP navigator. A larger, more rigorous trial is needed to further test the SBIRT PrEP model. Identifying methods to better address behavioral health concerns is critical to enhance PrEP participation and improve quality of life for individuals receiving PrEP.