Data-driven, peer-led messaging using social media influencers to increase PrEP awareness and uptake among transgender women

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Project Summary Transgender women (TW) are at significantly higher risk of getting HIV, yet research indicates they are less likely to use pre exposure prophylaxis (PrEP) and continue to have misconceptions about its utility. Trans- inclusive communication, delivered by trusted peers, is a potentially useful strategy to address this gap, but reaching a large number of TW can be difficult. The SIS (Sisters Influencing Sisters) study will use preliminary findings from a NIMH funded R21 that utilized commercial marketing techniques called perceptual mapping and vector message modeling to develop and concept test TW specific PrEP messages. Using the Gender Affirmation Framework and the EPIS Implementation Framework as guides, we propose to embed these tested PrEP messages and materials in the SIS intervention and pilot it using TW social influencers (SIs) via Instagram. Specific aims of the research are: Aim 1: Design a community-led, social-media based PrEP messaging training for TW SIs. We will recruit a Community Advisory Board (CAB) who will consult on all aspects of the study, including the development of an SI training and recruitment of SIs, tools/measures, dissemination of findings, and input on a future trial. Aim 2: Refine PrEP messaging materials, design the SIS intervention modules, and identify and train TW SIs. We will finalize PrEP messaging materials, engaging trans artists to refine images and convert to social media formats. With the help of our CAB, we will identify and engage SIs on social media from two intervention locations (San Francisco Bay, Philadelphia) and two comparison locations (New York and Los Angeles). Intervention SIs will be trained on the SIS intervention content as well as delivery of clinical referrals and resources to their communities. Aim 3: Aim 3: Pilot test the SIS intervention to collect feasibility, acceptability, and preliminary efficacy data to inform a full trial. We will implement standardized core components of the Instagram-based intervention, evaluate dissemination and reach of the PrEP messages, and monitor and evaluate engagement with the materials. To assess promise of efficacy, we will identify a cohort of 120 followers (80 intervention, 40 comparison) to complete baseline, mid and end of intervention surveys to track changes and compare levels of PrEP knowledge and PrEP perceptions. We will also pilot remote collection of hair samples to monitor PrEP uptake and use in a subsample of participants (n=30; 5 each SI) and do in-depth intervention implementation evaluation. We expect that findings will significantly contribute to our understanding of how to communicate with a diverse group of TW, how to leverage social media as a powerful communication channel, and how to disseminate information to increase PrEP awareness and uptake by addressing the unique HIV prevention needs and concerns of TW.