PROJECT SUMMARY When taken properly, PrEP effectively prevents HIV infection, and has been significantly associated with a reduction of HIV diagnoses among U.S. civilians. Within the U.S. military, 1,890 military members were diagnosed with HIV between the years 2013 to 2018, with an annual HIV incidence that has not decreased during that time. It has been found that HIV tends to affect similar demographics between military and civilian populations; namely members who are younger, black, and MSM. There is a critical need for PrEP scale-up in this vulnerable population, yet key factors associated with PrEP access and HIV infection are distinct among the military population and warrant exclusive assessments. The proposed cross-sectional study will be the first to scientifically examine multi-level factors associated with PrEP use, interest, and preferences among at-risk military MSM. These findings will provide insight into PrEP delivery factors necessary to optimize an evidence- informed PrEP intervention tailored to the specific needs and preferences of at-risk military MSM seeking care within a restricted healthcare context. The first aim of this study is to identify the relationships between the information (PrEP Knowledge, HIV Knowledge), motivation (anticipated stigma, prevention altruism, personal risk/safe sex practices, social/peer approval), and behavioral skills (daily, on demand, navigation of disclosure) factors predictive of PrEP interest, including preferences for and acceptability of PrEP among active duty military MSM. The second aim is to determine sub-groups that would benefit from alternative PrEP delivery models among an active duty, MSM military population using CBC analysis among the PrEP delivery factors. The proposed training plan includes an overview of coursework and scholarly/research activities that will establish a solid foundation in nursing science and subject-matter expertise related to the study, as well as specific experiences designed to refine my expertise in research methods and statistical analysis. Aligned with NINR’s strategic future directions in symptom science and wellness; the proposed study and training plan will provide an essential foundation for a career in nursing research developing biobehavioral interventions that will promote personalized HIV- prevention among a vulnerable population.

PROJECT NARRATIVE AND RELEVANCE Pre-exposure prophylaxis (PrEP) has been shown to be extremely effective agent at preventing HIV infection when taken daily as prescribed, yet knowledge and uptake of PrEP remains low among civilian populations. Although HIV tends to affect similar demographics between military and civilian populations, the annual incidence of HIV infection among U.S. military members has not decreased between the years of 2013-2018, and no studies to our knowledge have been published that examines knowledge, uptake or preferences of PrEP among at risk U.S. military members. The purpose of this study is to identify preferences and acceptability of PrEP for targeted interventions that will enable at-risk military populations to fully benefit from the current and future models HIV prevention interventions such as PrEP.