PROJECT SUMMARY/ABSTRACT Substantial measures must be taken in the United States to rectify the marked inequities in HIV pre-exposure prophylaxis (PrEP) outcomes among Black adults. PrEP implementation among Black populations is undermined by individual, interpersonal, and structural barriers rooted in stigma, racism, heterosexism, and sexism. Improving PrEP provision has become imperative as novel modalities emerge. There is an urgent need to develop implementation strategies that accelerate equitable PrEP delivery. The goal of this K23 is to facilitate Dr. Watson’s long-term goal to become an independent investigator focused on the development of implementation strategies to achieve equitable HIV prevention outcomes among Black populations. The proposed K23 will focus on designing and testing a multifaceted implementation strategy to support PrEP provision for Black primary care patients, grounded in an adapted conceptual framework that includes constructs from the Consolidated Framework for Implementation Research (CFIR) and Bandura’s Social Cognitive Theory. Dr. Watson’s proposed research plan will consist of training objectives in (1) qualitative research, (2) behavioral and social science research (BSSR), (3) community-engaged research, and (4) implementation science. With a focus on equity-centered applications within implementation science and community-engaged research, she requires further training in qualitative research, BSSR, and trial design to develop and pilot an implementation strategy to increase local PrEP provision capacity. These training objectives will be achieved through mentorship from an exemplary multidisciplinary mentorship team, complementary research aims, professional development activities, and coursework. Specifically, she plans to: (Aim 1) Identify key provider-, practice-, and community-level CFIR- based determinants of local PrEP delivery; (Aim 2) Develop a theory-informed multifaceted implementation strategy that follows a destigmatizing sexual health framework to accelerate equitable PrEP delivery for adult Black primary care patients; (Aim 3) Conduct a 12-month two-arm pilot trial to evaluate implementation strategy feasibility and acceptability at four medical practices that provide primary care services. The results of this study will be important for the field of implementation science as it focuses on facilitating theory- informed behavior changes among providers and practice leadership to accelerate equitable PrEP provision for Black primary care patients. Findings from the pilot will inform the design and submission of an R01 application for a hybrid effectiveness-implementation trial of the implementation strategy in year 4. The proposal will form a strong foundation for Dr. Watson’s continued development toward an independently funded research career as an implementation scientist invested in the development of implementation strategies to achieve equitable HIV prevention care outcomes among Black adults in the U.S.

PROJECT NARRATIVE There are marked inequities in HIV pre-exposure prophylaxis (PrEP) provision in the U.S., with Black individuals comprising only 10% of PrEP users, underscoring the urgent need for innovative research to optimize PrEP delivery for Black adults of all genders and sexual orientations. The proposed research will identify key determinants of PrEP delivery (Aim 1); develop a multifaceted implementation strategy to accelerate equitable PrEP delivery for Black primary care patients (Aim 2); and conduct a 12-month two- arm pilot to evaluate strategy feasibility and acceptability at four primary care practices in Philadelphia (Aim 3). Given the critical need to achieve equitable PrEP care continuum outcomes, this research will have significant public health implications.