Increasing HIV/STI Home Testing, Linkage to Care, and Linkage to PrEP via a Digital Intervention among Black Women in a Geographic Hotspot

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Project Summary: Racial and geographic disparities in HIV have increased in the US, particularly among Black women. Rural Black women are at greater risk of HIV infection, late-stage diagnosis, and are less likely to sustain viral suppression compared to other racial and ethnic minority women. Black women also have higher rates of sexually transmitted infections (STIs) than other women; many STIs have no symptoms, are undiagnosed, and are untreated. Having an STI triples one’s risk for contracting HIV. Evidence indicates that living in a rural community is a risk factor for lower rates of HIV screening, increased stigma surrounding an HIV diagnosis, later HIV diagnoses, late adoption of antiretroviral therapy, therefore leading to increase HIV- related mortality, highlighting barriers to testing, linkage to care, and linkage to pre-exposure prophylaxis (PrEP). Home HIV/STI testing has promise to increase rates of testing by circumventing barriers and thereby reduce medical costs through early detection and care. Home HIV/STI testing is also a prime opportunity to link Black women at high risk for HIV to PrEP. Yet, home testing alone may not overcome all barriers. Pairing home testing with an intervention designed to increase motivation and overcome barriers has the most promise to increase HIV/STI testing rates. The proposed supplement to the awarded R34 (1R34MH128054-01) aims to focus on Black women living in rural areas and conduct formative research (aim 1) that is imperative for intervention development (aim 2). The intervention draws on 3 components, the situated, information- motivation-behavioral (sIMB) model, mental contrasting, and implementation intentions to develop a new, web- based intervention. This intervention is comprised of 5 sessions: 1) using the HIV/STI home testing kit, 2) mailing in the kit, 3) checking results, 4) obtaining treatment, and 5) attending an appointment for PrEP. Each session is structured the same: information regarding the importance of each behavior, motivation via mental contrasting and methods to overcome the identified barriers, and behavioral skills to increase self-efficacy. The supplement will occur in 2 phases that coincide with the aims to develop and culturally tailor the intervention. 1) Conduct formative research to inform the development of the web-based HIV home testing intervention for Black women at high risk for HIV living in rural areas. We propose to conduct in-depth interviews with 20 Black women living in rural geographic areas in Central Texas to explore the constructs of sIMB, mental contrasting, and implementation intentions to develop the intervention protocol to be field tested in aim 2. 2) develop and tailor the web-based HIV home testing intervention for Black women living in rural geographic areas in Central Texas. We will develop the web-based intervention and field test the intervention among 10 Black women living in rural areas. The web-based design of the intervention greatly increases the opportunity for implementation on a large scale. The long-term goal is to increase HIV/STI testing among Black women in rural areas via scalable and sustainable methods to decrease HIV transmission and subsequent disparities.