May 5th, 2022 | Greidy Miralles, InCHIP’s Research Development Assistant

Roman Shrestha, PhD, MPH focuses on the improvement of HIV and substance use prevention among sexual and gender minority groups and people who inject drugs.

Roman Shrestha, PhD, MPH, an InCHIP principal investigator and Assistant Professor in Allied Health Sciences, primarily focuses on improving HIV and substance use prevention among sexual and gender minority populations and people who inject drugs, both domestically and internationally.

Shrestha is the principal investigator of four projects funded by the National Institutes of Health (NIH), these include the JomPrEP Project and the iRaPID Project. More info on these projects and his team can be found here.

Dr. Shrestha’s current research interests began to take shape in 2018 with a trip to Malaysia while he was a postdoctoral fellow at Yale. During this trip, Shrestha observed that in Malaysia, men who have sex with men were more likely to be infected with HIV and to engage in substance use. Likewise, preventative measures such as HIV testing and Pre-Exposure Prophylaxis (PrEP, a highly effective drug in preventing HIV) services were not widely implemented or utilized. In locales where sex between men is illegal and highly stigmatized – disclosure and fear often become significant barriers to accessing preventative healthcare even when available.

Shrestha quickly became interested in addressing these issues. He had proposed distributing evidence-based HIV prevention programs, like HIV testing and PrEP, using a mHealth platform.

“The mHealth platform has the potential to address multiple barriers to HIV prevention efforts in a confidential, less-stigmatizing, and convenient manner,” said Shrestha.

The JomPrEP Project is based in Malaysia. This project seeks to develop and test a clinic-affiliated smartphone app to improve access to HIV prevention services, like HIV testing and PreP, for men who have sex with men. Some of the key features of the app include ordering an HIV self-testing kit, PrEP medication, and party pack supplies, booking appointments, e-Consultation via the app, being able to review lab results via the app, the ability to chat with the clinicians, and also includes gamification features like receiving reward points for completing activities to improve user engagement and retention.

The JomPrEP app, which is now freely available in both IOS and Android platforms, has been having great success. “This project is changing the landscape of HIV prevention efforts in Malaysia. The app greatly improved access to HIV prevention services, and thus uptake of HIV and STI testing and PrEP medication in these underserved groups,” said Dr. Shrestha.

The second project, the iRaPID Project, focuses on developing an integrated HIV prevention service delivery method that is more accessible for people who inject drugs in the domestic setting. The systems of care for prescribing PrEP and medication for opioid use disorder (MOUD) are seemingly more complicated than they need to be. When treatment is not integrated, it creates excess demands on patients to engage with differing systems and clinicians, which is more challenging with patients like people who inject drugs, whose lives are often chaotic. With calls for increased task-shifting of HIV prevention services to improve access and utilization, this project aims to develop a nurse-led HIV prevention program that incorporates same-day access to PrEP and MOUD (i.e., buprenorphine, methadone). This HIV service delivery model represents an innovative approach to scale-up PrEP and MOUD services among this underserved group and achieve greater public health impact.

Dr. Shrestha’s future work involves the development and testing of a web-based platform to promote HIV testing and post-test linkage to HIV prevention and treatment services among men who have sex with men in Malaysia. “The newly developed intervention, called Jom-TestPlus, incorporates HIV self-testing with real-time e-counseling integrated with online-to-offline linkage to HIV and other harm reduction support services. It offers an innovative strategy that could transform the HIV prevention and care continuum among Malaysian men who have sex with men,” said Shrestha.

To view Dr. Shrestha’s past publications click here.