Tcher, Take Charge: Increasing PrEP Awareness, Uptake, and Adherence Through Health Care Empowerment and Addressing Social Determinants of Health Among Racially Diverse Trans Women in the Deep South

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Abstract Trans women are highly underserved in the response to HIV, especially in the deep south. Southern states are disproportionately impacted by HIV. Among states in the deep south, which face the vast majority of new HIV infections, HIV diagnosis rates in Louisiana were second only to Georgia. In New Orleans, our team conducted the first population- base HIV surveillance study of trans women and 46% tested positive for HIV. These findings are consistent with the most recent Louisiana Department of Health (LDH) STD/HIV annual report in 2018 that identified Black gay/bisexual men and transgender women as bearing the largest burden of HIV of any population in Louisiana. Despite the impact of HIV on trans women in New Orleans, no evidence-based PrEP interventions or efforts are underway to meet community needs. In response to RFA-MH-21-151 Strengthening HIV Prevention Efforts for Women in the Southern U.S., our team proposes to test the T'Cher, Take Charge intervention to increase PrEP awareness, uptake, and adherence among trans women in New Orleans. T'Cher builds off the work conducted to inform and implement the first population-based study of trans women in 2019 with the adaptation of two evidence-based interventions for trans women recently completed by investigators. The intervention will include a social media campaign to increase PrEP awareness among trans women. It will also include peer navigation to build trust among trans people and provide PrEP navigation. We will tailor the peer navigation model from the Stay Study to be implemented digitally and enhanced using Health eNav methods. Namely, we will also use motivational interviewing and EMAs to increase health care empowerment and address social determinants of health barriers to PrEP uptake and adherence. We will recruit 200 trans women to participate in our study using methods proven successful in our prior HIV research with trans women. Trans women will be engaged in the intervention for 12 months, providing enough time to address barriers to PrEP and support adherence. The goals of this proposed T'Cher, Take Charge intervention are: (1) To develop, implement and measure the impact of a T'Cher, Take Charge social media campaign on PrEP awareness among trans women in New Orleans, LA using a population-based sample of trans women; (2) To test the impact of the T'Cher, Take Charge digital mHealth peer navigation model on increasing PrEP uptake and adherence among trans women in New Orleans, LA, using a randomized stepped wedge cross-over study design; and, (3) To assess changes in health care empowerment and support for social determinants of health as mediating factors in PrEP uptake and adherence. Our goal is to used lessons learned to adapt promising trans-specific HIV interventions to meet the HIV prevention needs of trans women in New Orleans, Louisiana. With evidence of effectiveness, we are prepared to test the intervention at scale throughout Louisiana to strengthen PrEP access and utilization among trans women Louisiana and throughout the deep south.