Developing and pilot testing an eHealth decision support tool for young trans women to improve informed decision making about PrEP

Project Summary Transgender women (TW) have the highest rates of new HIV infections in the US yet are less likely to be aware of, use, or adhere to PrEP. This is especially worrisome as new modalities beyond daily oral (i.e. injectable, longer acting pills) are quickly coming on the market, making decision making and clarifying preferences crucial

to uptake. Importantly, missing in much of the research on barriers to PrEP uptake are the voices of young (15- 24) trans women (YTW), who may also experience age-related barriers to PrEP decision making, such as confidentiality and conflicts with family during transition, and lack of a supportive community with credible

spokespeople whom they trust. No interventions have developed decision support tools (DSTs) to help YTW make decisions about PrEP in line with their individual preferences and cultural values delivered in non- traditional venues that meet YTW where they are. The primary goal of this study is to develop and evaluate the

feasibility, acceptability and promise of efficacy of an electronic health DST called QUEEN-P (QUestions to Empower and ENgage with PrEP) to increase PrEP informed decision making among YTW in Philadelphia. Using commercial marketing techniques – perceptual mapping and vector message modeling – and grounded in

the Ottawa Decision Support Framework, QUEEN-P will be delivered via tablets or other devices in novel locations (mobile vans, house and ball events), working with community partners known to be trusted by YTW. Specific aims are: 1. Assess YTW perceptions of PrEP, different delivery methods and potential barriers to

initiation and adherence. We will establish community and scientific advisory boards (CAB/SAB) made up of YTW and healthcare providers and community advocates, survey YTW (n=100) and use perceptual mapping analyses to develop targeted messages, elicit feedback from the CAB/SAB on content and delivery of QUEEN-P;

2. Develop the QUEEN-P eHealth DST and assess usability and acceptability. We will develop a prototype DST and concept-test messages and features with our CAB/SAB for feedback on acceptability, revise it based on feedback and conduct user testing with YTW (n=20); 3. Pilot the intervention to assess for promise of efficacy in

engaging YTW in PrEP informed decision making and assess interest in and outreach to community clinical partners for PrEP. We will conduct a pilot test with YTW (n=60) in Philadelphia randomized to an “Enhanced” (QUEEN-P + navigation to culturally competent PrEP providers) or “Basic” study arm (basic PrEP information

and a list of resources). To assess promise of efficacy, we will compare outreach to clinical partners and decisional conflict (primary outcomes) at 3-month follow-up and assess decision preparation, self-reported knowledge and attitudes, and PrEP uptake (secondary outcomes; immediate post, 3 month follow-up).

Qualitative exit interviews will inform feasibility and acceptability. This pilot study will examine the potential impact of using technology based, salient, gender-responsive interventions to improve PrEP informed decision making in a population at high risk of HIV acquisition.