PS24-063, MARI: Refining and pilot testing an intervention to improve PrEP uptake among marginalized Black cisgender women PrEP-WISE

Abstract The scale-up of pre-exposure prophylaxis (PrEP) is a prominent component of the U.S. Ending the HIV Epidemic Plan. Although Black women are disproportionately affected by the HIV epidemic, they are less likely to benefit from PrEP. Further, the literature on evidence-based interventions to improve PrEP uptake among Black women is sparse. The central aim of this MARI application is to refine and test PrEP-WISE (Pre-exposure prophylaxis for Women In-charge of Sexual decision-making and Engagements), a novel, peer-led intervention designed to increase PrEP uptake among cisgender Black women (BW) who live in New York State. Intervention mapping (IM)1, 2 will be used to refine the intervention which will be grounded in the Theory of Gender and Power (TGP) and Information-Motivation-Behavioral Skills model. This study will include 185 cisgender BW and 15 PrEP providers (PP). The specific aims of the study are: Aim 1. Refine and manualize PrEP-WISE among cisgender BW (N=25) and PrEP providers (N=15). First, we will conduct 6 focus group discussions (FGDs) (2 among providers, 2 among cisgender BW and 2 mixed group) to elicit feedback on PrEP-WISE. Second, we will theater test (TT) the intervention among a sub-set of the participants in the FGDs (N=15). Thematic analysis will be used to analyze the data. Aim 2. Test PrEP-WISE among 160 cisgender BW using a 2-arm (1:1 ratio) randomized controlled trial (PrEP-WISE and waitlist control arm) to assess efficacy on PrEP uptake at 3- and 6- months post intervention. Aim 3: Assess acceptability and feasibility of the intervention and identify strategies for scaling-up PrEP-WISE. We anticipate the intervention will include 4 modules: (1) Assessing HIV vulnerability (self, partner, and environment); (2) Building skills to talk to providers and partners about HIV prevention and overcome mistrust; (3) PrEP 101 and Combating stigma – no shame in taking action to reduce HIV vulnerability; and (4) Personal Finance 101: Everything You Need to Know (a free 3-hour Udemy Course). PEP-WISE will also provide BW with a peer-navigator who will use motivational interviewing techniques to help them problem- solve and access PrEP. This will be bolstered with a WhatsApp support group, and transportation support ($20) for visiting a PrEP Provider. All participants will be provided with the links to the CDC’s HIV Services Locators and New York State Department of Health PrEP-AP. A MARI award will provide the support and protected time required for a highly rigorous and intensive career development experience in designing and analyzing randomized controlled trials. Importantly, it will build my capacity to transition to independence as an investigator with expertise in developing evidence-based interventions to address HIV inequities among marginalized populations. I have assembled a strong team of mentors and collaborations with complementary and integrated expertise in HIV prevention, development of theory-based and culturally grounded prevention intervention, recruitment and retention of women, and collection and analysis of qualitative and quantitative data. The team is committed to providing the guidance and support required for me to achieve my research and career goals.