PrEPwise Pilot Among Black Women in Eastern Virginia

HIV is a virus that affects many people, but Black women in the U.S. are a population at a much higher risk of getting it compared to white women-about 18 times higher. Pre-exposure prophylaxis (PrEP), a medicine if taken as recommended by a clinician can prevent HIV almost completely (99% effective). The problem is that many Black women, especially those living in the Southern U.S., don't know about this medicine called PrEP or find it hard to access it. To address this, healthcare providers sometimes use "decision aids" which are tools, like brochures or videos, designed to help people understand their medical options and make informed choices based on what's important to them. While these tools have worked well for other health issues, they haven't been widely used for preventing HIV. The challenges are doctors do not have enough time to explain PrEP fully to patients during clinic visits and also some Black women do not trust the healthcare system because of a long history of unfair treatment toward Black communities. Community health workers (CHWs) are trained health workers from the same communities as their patients and can facilitate their ability to provide culturally appropriate health education and information consistent with patients' values and needs. Because of this, patients are often more comfortable talking to them. This project aims to test the acceptability and effectiveness of a decision tool to be integrated into HIV testing services to help Black women decide if PrEP is right for them. The investigators are calling this intervention PrEPwise. A tool originally designed for women dealing with opioid addiction will be adapted to fit the needs of Black women living in the South. The long-term goal of this project is to make it easier for Black women to learn about PrEP and decide whether to use it, ultimately helping lower the number of new HIV cases in Black women.

The study will follow a type-1 effectiveness-implementation hybrid design as a single-site, single-blinded randomized controlled trial. The following procedures detail the study conduct and masking approach: Baseline Visit: * Informed consent process * Collection of demographic information * Administration of baseline survey assessing: Perceived HIV risk, PrEP knowledge, PrEP attitudes, PrEP stigma, Discrimination/racism experiences, PrEP norms, Decisional conflict, and Self-efficacy Randomization and Intervention Delivery: * Random assignment will be conducted at the individual level with 1:1 allocation using random block sizes of 2 * Randomization assignments will be generated through REDCap's randomization module by the study data analyst * Only participants will be blinded to their study arm assignment. Study staff delivering the intervention cannot be blinded due to the nature of the behavioral intervention * Participants will be informed they will receive either enhanced or standard HIV prevention information, without specifying their assigned arm * The research assistant conducting outcome assessments will be different from the staff delivering the intervention * Immediate post-intervention survey assessing implementation outcomes * Intervention acceptability * Intervention feasibility * Intervention fidelity 3-Month Follow-up Visit: * Assessment of effectiveness outcomes: * PrEP initiation status * PrEP persistence * Changes in baseline measures * Collection of pharmacy fill data. At the 3-month follow-up visit, participants will be asked to self-report whether they initiated PrEP and if they obtained refills. Additional Procedures: • Qualitative interviews with a subsample (n=20) of participants to explore perspectives about intervention acceptability, fidelity, barriers, and recommendations for adaptations The research hypothesis is: Compared to the control arm, the intervention arm will have (1) a higher percentage of Black women initiate PrEP at 3-months, (2) increased PrEP and HIV risk awareness at 3-month follow-up, (3) reduced HIV PrEP stigma, (4) increased trust in healthcare, and (5) Increased decisional certainty in the choice and intention to use PrEP at 3-month follow-up.