Leveraging video logs as a bridge to pre-exposure prophylaxis (PrEP) with tailored messaging to Black women and their healthcare providers in Texas

Achieving the nation’s Ending the HIV Epidemic plan goals will require a significant increase in access to and uptake of pre-exposure prophylaxis (PrEP) among Black women. Black women continue to bear a disproportionate burden of new HIV cases through heterosexual contact and are far less likely to use PrEP. These factors magnify the health and social consequences of HIV to Black women. Although PrEP is available, Black women are among the least likely groups to use it, as only 2% of PrEP-eligible Black women have reported PrEP use, which amplifies a significant unmet prevention need. In order to increase PrEP use with eligible Black women, researchers must identify strategies with capacity to build a secure bridge of connection between Black women and healthcare providers that can withstand formidable barriers to PrEP uptake (i.e. medical mistrust, provider bias and stigma). Support by providers who are knowledgeable, willing, and comfortable with prescribing and referring PrEP to Black women is necessary to increase PrEP initiation among women. The primary objective of this R34 proposal is to increase willingness for PrEP initiation and PrEP initiation among Black women and increase willingness to prescribe/refer PrEP to Black women among healthcare providers in Houston/Harris County, a high priority Ending the HIV Epidemic jurisdiction. We hypothesize that a video-log (vlog) series-based health communication intervention disseminated through community health centers and social media will increase PrEP initiation among Black women by supporting both Black women and providers in a way that will foster PrEP access and uptake. Specifically, the intervention will: 1) increase willingness to access and use PrEP among women and 2) increase willingness to prescribe and refer PrEP to women among providers. Our team will explore two aims to 1) inform and develop health messages for Project ROLE with 2023 findings from focus groups with PrEP-eligible Black women and key informant interviews with providers providing care to women and 2) assess the feasibility, acceptability, and preliminary impact of Project ROLE in two real-world settings with a pilot randomized controlled trial and a social media campaign. The use of two ‘real-world’ settings to evaluate the feasibility and acceptability of this study is highly innovative. The proposed research is significant because it will connect women to PrEP while increasing provider’s willingness to prescribe and refer PrEP to them using health communication that can guide the development of subsequent vlog-based interventions to address the national Ending the HIV Epidemic plan.