Project SummaryAs we edge closer to the half century mark of the HIV epidemic, the disproportionate effect on women of colorin the U.S. continues to be jolting. Women overall have been at a disadvantage in the epidemic due to genderdifferences and norms that shape biological, social and economic vulnerability. Racial and ethnic disparitiesmagnify the risk. Co-factors such as alcohol and other drug (AOD) use intersect and reinforce othercomorbidities. Living in a high prevalence area significantly hardens the risk and makes it tougher toovercome. Options to help women stay HIV negative have been limited. However, this obstacle shifted severalyears ago with FDA approval and CDC endorsement of oral pre-exposure prophylaxis (PrEP). Yet, the majorityof U.S. women do not know that PrEP can be a female-controlled strategy or that it applies to them—andbackup has not been forthcoming from providers or their communities. What is most disturbing, however, is theabsence of PrEP as an accessible strategy among women of color in high impact regions of the country. Thisdevelopmental U34 responds to RFA-AA-17-013, which prioritizes community based participatory research(CBPR) to develop implementation models for women that address alcohol and HIV in high impact regions andcommunities. The proposed study will produce an evidence- and CBPR-driven PrEP implementationintervention to enhance uptake and optimize use among women of color in South Florida, which is currently thehighest impact region of the U.S. with HIV rates recently determined by the CDC to be the highest in thenation. The study builds upon the team’s experience in alcohol/HIV intervention and CBPR in South Floridaand preliminary work with stakeholders from the greater Miami and Fort Lauderdale areas to develop a multi-level PrEP intervention program for African American, Latina, and Haitian women who engage in risky sex andAOD use. The study includes researchers from the Southern HIV and Alcohol Research Consortium (SHARC)and will inform the design of target and comparison groups and other features of a U01 for further study withinthe NIAAA CHAART Consortia. Guided by the social ecological framework, the study will: identify needs,priorities, and community strengths and develop a PrEP continuum during a summit to engage stakeholders(Aim 1); produce a replicable implementation program, including manuals, materials, instruments, andprocedures, through the formation of a Community Advisory and Advocacy Board (Aim 2); and conduct anexploratory pilot among 120 multi-ethnic women of color in Broward and Miami-Dade counties to test fidelity,feasibility and acceptability and measure PrEP uptake and adherence and retention in care over a 6 monthperiod. The study will utilize biomarkers in a subsample to compare with self-reports and pharmacy refillmeasures. It will be among the first to develop a PrEP intervention in the South for women of color, and is thusin line with the specific high funding priorities of the Office of AIDS Research on cross-cutting research toreduce health disparities in developing implementation approaches for bio-behavioral strategies such as PrEP.
