Developing an online decision support approach leveraging social media to promote PrEP awareness and demand among women in the Southeastern US

PROJECT SUMMARY/ABSTRACT Women constitute an estimated 20% of new HIV diagnoses in the United States, with the highest burden of cases among women in the Southeast. Low pre-exposure prophylaxis (PrEP) utilization among women presents a challenge to addressing the burden of HIV in the Southeast and ending the US HIV epidemic. Only an estimated 2% of the 170,000 women who could benefit from PrEP are using it. Low PrEP use among women in the US may be attributable to lack of awareness and beliefs that PrEP is not appropriate for women. Fewer than 15% of women with HIV risk indications are aware of PrEP. Many women who are aware of PrEP believe that it can only be used by men, or believe that PrEP is not appropriate for them due to low perceived HIV risk. Building on an existing website prototype and prior PrEP messaging research, we propose a web-based awareness raising and demand creation approach consisting of a website with tailored PrEP information and decision support disseminated through social media to women throughout the Southeast. In Aim 1 we will develop a replicable social media targeting approach optimized to engage women with indications of PrEP need. This will generate ad campaigns refined through focus group discussions followed by a social media targeting study to identify social media platforms and targeting terms for engaging women with PrEP need. In Aim 2 we will build the PrEP decision support website based on existing prototype content. To update website content, we will conduct a preference elicitation study to expand the site to address long-acting PrEP methods followed by user testing to refine the website with input from women throughout the Southeast. In Aim 3 we will conduct a pilot trial of the PrEP decision support website with 100 women recruited through social media to evaluate intervention feasibility, acceptability, and appropriateness and to explore intervention effects on PrEP interest and uptake. Women will be randomized to receive either the decision support website or a standard education website and linked to a PrEP finder site to facilitate connections to PrEP providers. We will conduct in-depth interviews with women receiving the PrEP decision support website to understand their experience of the intervention. If the intervention proves feasible and shows promise to promote PrEP interest and uptake, this study will lay the foundation for a larger randomized controlled trial to evaluate the intervention effect on PrEP uptake among women in the Southeast with indications of PrEP need. Ultimately, the PrEP decision support website and social media dissemination strategy may provide a wide-reaching approach to promote need- proportionate PrEP uptake among women.