GODDESS (Gathering Online for Dialogue and Discussion to Enhance Social Support): Engaging young African American women in a virtual group app to address alcohol misuse, sexual risk, and PrEP in NC

The intersection between alcohol and other drug (AOD) use among young Black women at risk for HIV is a public health issue. Recent epidemiological data highlight increases in alcohol misuse among young Black women. These issues are coupled with high rates of HIV and other sexually transmitted infections (STIs). Addressing this difference in HIV acquisition is key to ending the HIV epidemic and improving the health and well-being of all, particularly in the U.S. South. Consequently, there is a critical need to decrease alcohol use and impaired sex and to increase pre-exposure prophylaxis (PrEP) uptake as prevention for this population. The proposed study builds on decades of research of a best-evidence intervention, including collaboration with health departments to address AOD use, sexual risk, and violence prevention. Most recently, the study team found the delivery of the intervention via mobile health (mHealth) had findings comparable with face-to-face delivery, with reduced odds of heavy alcohol use and impaired sex, suggesting that scalability via mHealth is a viable option. The next logical step is to add and test a virtual group component, as recent participant feedback across several studies in North Carolina has shown additional group engagement and support is highly desired. Consequently, in response to RFA-AA-21-016: HIV Prevention and Alcohol, this application addresses the following specific aims: Aim 1. To modify an evidence-based mHealth AOD use and sexual risk reduction intervention to include a virtual group component and information about PrEP for utilization. Initial research activities include focus group discussions with young Black women who misuse alcohol and service providers, as well as pretesting of the virtual group component. This brief iterative process will include modifications and refinements based on content (PrEP) and technology (from tablet to smartphone) and will include review from our Community Collaborative Board. Aim 2. To test the modified mHealth intervention (with the group component) relative to the mHealth intervention in a two-arm randomized trial with young Black women (aged 18 to 30) who misuse alcohol. A total of 500 participants who are HIV-negative who engage in heavy alcohol use will be enrolled across two North Carolina counties and referred to their local health departments for PrEP. Primary biobehavioral outcomes assessed will include reduced alcohol use (self-reported and biological, including PEth), increased PrEP uptake (self-reported and biological), and reduced sexual risk (self-reported condomless sex and impaired sex and biological testing for HIV) at 3- and 6-month follow-ups. Aim 3. To assess acceptability, adoption, and cost of the virtual group component as a strategy to increase engagement with the mHealth intervention and PrEP utilization. Acceptability will be assessed via satisfaction surveys and post-study interviews, adoption via data analytics measuring engagement in the group and examined as a meditator of intervention outcomes, and cost via data collected about time and resources of implementing the group component.