Start the conversation: A multi-level PrEP initiative for Black women in NOLA

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PROJECT SUMMARY The rate of HIV diagnosis among Black cisgender women in Louisiana is almost 7 times higher than of White cisgender women. Multi-level implementation strategies are critically needed to reduce HIV infections among Black cisgender women in New Orleans, Louisiana (NOLA), an Ending the Epidemic priority jurisdiction. Using findings from our recently-conducted qualitative interviews with Black cisgender women and contributions from NOLA’s Black Women and PrEP Task Force, we have identified two main barriers that limit PrEP uptake among Black cisgender women in NOLA: (1) Black cisgender women do not know of other Black cisgender women taking PrEP, and (2) Black cisgender women are not offered PrEP during routine medical care. To address these determinants, we propose to develop and pilot a Start the Conversation Initiative that includes implementation strategies at the patient and provider levels. Aim 1 focuses on developing the patient-level implementation strategy, a social media campaign. Working with the Black Women and PrEP Task Force and a local community-based organization that specializes in social media campaigns, we will determine the content of the social media messages and the type of social media to use. We will conduct 4 focus group discussions with Black cisgender women to pre-test the social media content. Aim 2 focuses on developing the provider-level implementation strategies. We will develop a combined-care PrEP model that encourages GYN residents to (1) start a PrEP conversation with their patients and help them to determine if PrEP is right for them, and (2) help their patients to determine the best location of PrEP follow-up—either with the GYN residency clinic or with a routine PrEP provider. We will conduct 12 in-depth interviews (IDIs) with GYN and routine PrEP providers and establish a working group of GYN residents, GYN residency directors, and current PrEP providers to inform the combined-care PrEP model. In Aim 3, we will evaluate the implementation of the Start the Conversation Initiative. We will pilot the strategies at the Louisiana State University (LSU) GYN residency program over an 8-month period to inform acceptability, feasibility and potential impact. We will first implement the provider-level strategies, then layer in the patient-level strategies to examine impact on patient demand (PrEP uptake) and retention. The 8 months of combined implementation will be compared to PrEP uptake from a comparison GYN clinic at Tulane; one month retention in care outcomes will be measured at LSU. Implementation outcomes (adoption, fidelity, maintenance) will be assessed through chart review and triangulated with resident feedback sessions. We will also conduct 24 IDIs each with providers (n=12) and patients (n=12) to further inform acceptability, feasibility and appropriateness. At the end of the R34, we plan to submit a larger implementation research proposal with additional sites in the U.S. South to evaluate these optimized community-identified implementation strategies.