Hippocampo-neocortical interaction as compressive retrieval-augmented generation.

Men who have sex with men (MSM) are currently the largest population at risk for acquiring HIV in the U.S. and make up more than two-thirds of the nearly 1.2 million individuals living with HIV . Pre-exposure prophylaxis (PrEP) added a promising tool to help end the HIV epidemic, with oral PreP being the most widely available option, yet real-world gains have been slow to appear and are inconsistent across populations. The expected benefits of PrEP have been impeded by suboptimal uptake, adherence, and persistence in PrEP care . Moreover, these impediments occur in the context of a disproportionate burden of multiple reinforcing psychosocial syndemic factors among MSM, which drive HIV related behaviors and HIV acquisition risk . Life-Steps is an evidence-based treatment built on the principles of motivational interviewing (MI) and cognitive behavioral therapy based strategies (CBT) . It has been successfully adapted and for a number of different populations living with HIV across the globe. Additionally, it has been adapted for use with oral PrEP in heterosexual couples in Uganda , MSM , as well as oral and injectable PrEP in a large scale international prevention trial . An adaptation for MSM PrEP users included a small 2-arm randomized controlled pilot trial . Although too small to establish efficacy (N=50), this pilot study found the Life-Steps intervention to be both feasible and acceptable, and participants in the Life-Steps condition showed higher TFV-DP in dried blood spots (DBS) at 6-month follow-up relative to controls. Given the promising outcomes of the Life-Steps intervention internationally and in small-scale U.S. trials, a logical next step is to test the intervention in a larger U.S. sample, under conditions that better represent real world application. The present study is seeking to evaluate the effectiveness of Life-Steps for PrEP intervention to increase medication adherence in sexual and gender minority (SGM) participants prescribed PrEP who evidence at least one psychosocial syndemic factor which could potentially affect adherence. The primary outcomes are the number of participants in each condition who maintain a protective PrEP level over the 18-month study period as assessed by quarterly DBS analysis and differences in self-reported adherence (continuous measure) between the two arms. Additionally, the study will examine the degree to which enhanced maintenance of PrEP adherence occurs in the context of the conceptual mediators and potential moderators of the intervention. Finally, we are seeking to estimate the total and incremental costs of the Life-Steps for PrEP, stepped-care PrEP adherence intervention relative to standard of care (SOC), from healthcare sector and societal perspectives.