Centering Those Engaged in Transactional Sex: A PrEP Innovation for Getting To Zero

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Getting to Zero (GTZ) new HIV infections by 2030 is a public health priority. Increasing HIV prevention, self- management, and harm reduction among at-risk populations is critical. HIV prevalence in sex workers is 12 times greater than the general population, highlighting the need for targeted prevention efforts. Increasing optimal use of pre-exposure prophylaxis (PrEP) in this population will advance progress toward GTZ 2030. Community empowerment interventions reduce HIV risk among sex workers because interventions are collaboratively designed, implemented, and evaluated by the target population. A community-empowered PrEP navigation approach may be feasible and acceptable among sex workers. One such approach is a group healthcare model called Centering Healthcare (Centering), which originated as a group prenatal care model and has since been modified for various patient populations. Centering's three core components: healthcare, interactive learning, and community building, disrupt typical healthcare power hierarchies by creating a respectful and collaborative interactive learning environment that honors group needs. The model's positive impact links self-management goals and health assessment with interactive activities to foster health promotion. Using an implementation science framework and building on Centering intervention effectiveness, this study will be the first to evaluate whether Centering is feasible and acceptable for PrEP education, navigation, and adherence among sex workers. Preliminary qualitative research with 39 sex workers in Chicago highlighted that stigma and healthcare discrimination dissuaded sex workers from regularly accessing HIV prevention information, services, and treatment. In collaboration with sex workers and a Community Advisory Board (CAB), we culturally adapted the Centering curriculum and facilitator's guide to meet the stated needs of sex workers. Guided by an Exploration, Preparation, Implementation, Sustainment framework (EPIS), the overall goal of this study is to expand on my formative research and evaluate if this culturally adapted Centering PrEP (C-PrEP+) model is feasible and acceptable for addressing education, navigation and PrEP adherence needs of HIV negative sex workers in Chicago. Specific aims of this study are to 1. Produce an implementation plan for integrating C-PrEP+ into a Federally Qualified Health Care (FQHC) system. 2. Conduct a pilot feasibility and acceptability trial of C-PrEP+. 3. Complete an evaluation of C-PrEP+ to document implementation barriers and facilitators. The research plan will be augmented by expert mentoring and didactic research training at University of Illinois Chicago and University of California San Francisco. This proposal, mentoring, and coursework will provide essential career development in: 1. Quantitative methods, 2. Health intervention study design, preparation, implementation, and 3. Mixed-methodological evaluation. This foundation will uniquely position the PI to lead a fully powered multi-site RCT to determine if C-PrEP+ is an efficacious and sustainable model to address HIV prevention among sex workers.