Optimizing PrEP Uptake & Adherence Among Male Sex Workers (MSW) Using a 2-stage Randomization Design

The "PrEPare for Work" package includes two behavioral intervention components:

1. Strengths-based case management for PrEP initiation, and

2. Counseling and problem-solving PrEP adherence intervention that addresses individualized
barriers to optimal use.

Stage 1: MSW will be equally randomized to receive either the strengths-based case management
or standard of care referral to PrEP clinic.

Stage 2: Those from stage 1 who initiate PrEP , regardless of stage 1 randomization
condition, will then be equally randomized to either the "PrEPare for Work" adherence
intervention or standard of care comparison condition.

Inclusion Criteria:

- 18 years of age or older

- Biological male at birth and current male gender identity

- Exchanged sex for money or drugs with another man in the past 3 months

- Report behavioral risk for HIV infection, consistent with Centers for Disease Control
and Prevention guidelines for prescribing PrEP: condomless anal intercourse with at
least one HIV-infected or unknown serostatus partner in the past three months

- HIV uninfected by antibody test* Stage 2

- Able to understand and speak English (for consent and counseling)

- Mental competency to provide voluntary informed consent

- Lives in the New England area

- Willing to initiate PrEP

Exclusion Criteria:

- Unable to provide informed consent, including as a result of severe mental illness
requiring immediate treatment or mental illness limiting the ability to participate

- HIV Positive at baseline

- Infected with Hepatitis B or diagnosed with renal insufficiency (glomerular filtration
rate < 50) *Stage 2

- History of or current medical conditions that would preclude taking Truvada for PrEP
*Stage 2

- Currently taking Truvada for PrEP