Getting to yes: Pilot sequential multiple assignment randomized trial of motivational enhancement interventions targeting preexposure prophylaxis use in sexual minority men who use stimulants.

Objective: This pilot sequential multiple assignment randomized trial estimated the feasibility, acceptability, and scalability of telehealth motivational enhancement interventions for optimizing HIV prevention efforts in sexual minority men (SMM) who use stimulants.

Method: Seventy SMM who use stimulants with nonreactive HIV results that were not taking preexposure prophylaxis (PrEP) were randomized to: (a) a two-session motivational interviewing (MI) intervention focusing on PrEP use and concomitant risk behaviors; or (b) a contingency management (CM) intervention with financial incentives for PrEP clinical evaluation ($50) and filling a PrEP prescription ($50). After 3 months, participants who reported they had not filled a prescription for PrEP were randomized a second time to: (a) switch to a second-stage intervention (i.e., MI + CM); or (b) continue with assessments only.

Results: There was a robust engagement in the interventions, which participants described as flexible and nonjudgmental. Participants reported using CM incentives to meet basic needs and indicated that MI sessions improved their understanding of PrEP. The estimated cost of intervention delivery per participant was $404 for MI, $236 for CM, and $475 for MI + CM. Across both randomizations, participants who received CM only were most likely to provide verified evidence of PrEP use over 6 months, and there were potential benefits for reducing concomitant risk behaviors in nonresponders receiving MI + CM. Prior PrEP use and increases in PrEP intentions were significantly associated with verified PrEP use.

Conclusion: Although more definitive trials are needed to examine effectiveness, telehealth motivational enhancement interventions are promising, scalable approaches for optimizing HIV prevention among SMM who use stimulants. (PsycInfo Database Record (c) 2025 APA, all rights reserved).