Optimizing PrEP uptake for African American women in the South by empowering women to make informed HIV prevention and sexual health choices

Project Summary Black women are disproportionately impacted by HIV accounting, for 54% of new infections while constituting only 13% of women in the US in 2019. These disparities are even more prevalent in the South. Pre-exposure prophylaxis (PrEP) is an effective biomedical preventive measure for HIV. PrEP is available in both oral and

injectable formulations, providing options for enhancing PrEP uptake and persistence. However, PrEP is underutilized among women, with only 10% of eligible women being prescribed PrEP in 2019. In the South, historical racism, gender-based discrimination, and the absence of integrated family planning and

prevention-oriented sexual healthcare combine to contribute to low PrEP use Black women. Such factors include: limited PrEP awareness, low perceived risk of acquiring HIV, HIV-related stigma and discrimination, concerns about side effects, costs, limited marketing to Black women, medical mistrust, and

limited availability and access to PrEP. Further, systemic racism, sexism and classism, race-based stereotypes, gendered social norms, and microaggression may render Black women less empowered to make decisions on their sexual health. Given the complex interplay of HIV-related stigma, racism and discrimination experienced by Black women, a holistic approach encompassing PrEP education,

enhancing access, building resilience, and sexual empowerment has the potential to facilitate PrEP deliberation, decision-making, uptake, and persistence. Although Black women are at higher risk for HIV, limited interventions are available to optimize PrEP uptake and persistence among this population. This study aims to address this by developing and pilot testing the

telehealth intervention EMPOWER (Enhancing and Motivating PrEP Options among Women through Empowerment and Resilience). The study aims include: Aim 1. Assess the sexual health and PrEP- related values, preferences, perceptions and needs of Black women to inform development of the EMPOWER intervention. Guided by a conceptual framework of intersecting racial and gender-based

discrimination theories (Theory of Gender and Power and the Minority Stress Model), in-depth interviews will be conducted with 20 Black women and 20 healthcare providers. Aim 2. Refine the EMPOWER intervention and online platform for improving PrEP decision-making among Black women. An open trial with 20

Black women will be used to evaluate and refine intervention content and delivery, interventionist training and supervision, fidelity rating, and study assessment procedures. Aim 3. Conduct a waitlist-controlled, randomized pilot trial of the 6-session group intervention using a cross-over design with 80 Black

women. We will assess the intervention’s feasibility and acceptability. Clinical outcomes will be PrEP uptake and persistence measured by Tenofovir Diphosphate (TDV-DP) concentrations in dried blood spot at baseline, 3- and 6-months post-intervention compared with standard of care (opt-out PrEP) at the intervention site.