HIV disproportionately affects Black cisgender women living in the United States south threatening progress toward the Ending the HIV Endemic initiative's 2030 goals. Although Pre-exposure Prophylaxis (PrEP), an oral or injectable medication that if taken is highly effective in preventing HIV, Black cisgender women have not equitably benefited from its use due to multiple complex factors. For example, lack of awareness and knowledge to PrEP, not trusting PrEP, PrEP stigma, providers not knowing about or offering PrEP, accessibility, and cost. These factors all contribute to only 2% of eligible women taking PrEP. Thus, interventions that take into consideration the lived experiences and broad culture for Black cisgender women are urgently needed to take a woman from medication precontemplation to uptake to maintenance. In partnership with Black cisgender women, an established community advisory council (CAC), an online telehealth platform (Q Care Plus), and beauty salon stylists, the research team co-developed Using PrEP, Doing it for Ourselves (UPDOs) Protective Styles, an e-Health intervention that strongly considers the unique needs of Black cisgender women, consisting of a training for stylists to become opinion leaders (trusted gatekeepers who share health information in the community) in HIV prevention (i.e., PrEP) and a 6-week web- based, edutainment video series (i.e., six 20-minute episodes), structured debrief blogs, and telehealth service access. The CAC was invaluable in this development process having collaborated with the research team across sexual health-based projects that informed and contributed to UPDOs preliminary research. UPDOs web content share core concepts by telling the stories of women from various backgrounds and role-plays a woman's decision-making process to use PrEP. Pilot research found UPDOs acceptable, improved PrEP trust, increased knowledge – for both PrEP aware and unaware participants, and decreased perceptions of PrEP stigma within personal relationships. This proposed effectiveness-implementation type I hybrid study will test UPDOs effectiveness in a larger, more geographically diverse sample using a cluster-randomized control trial and examine implementation determinants of UPDOs. In collaboration with Q Care Plus, a secure online platform to access telehealth services for home delivered HIV testing and PrEP prescriptions, we will track how many women reach out to a provider, get HIV testing, start PrEP, and maintain PrEP as prescribed. A cohort of 32 beauty salons will be randomized to either an intervention group (n=16) or control group (n=16). Salons (1 salon = 1 cluster) will be randomized to UPDOs (Edutainment videos + blogs + Q Care Plus) or usual care (CDC videos + website) conditions. Once salons are randomized, the recruitment and enrollment period of female customers will occur over 24-months. Study participation will include data collection at baseline with follow-up measures at 1, 12, 24, 32, and 52 weeks. To assess implementation outcomes and context, we will use a mixed methods approach guided by the Consolidated Framework for Implementation Research (CFIR).

We propose an effectiveness-implementation type I hybrid study to test an intervention, Using PrEP, Doing it for Ourselves (UPDOs) Protective Styles, and its effectiveness to improve PrEP uptake among Black cisgender women using a cluster-randomized control trial and examining implementation determinants of UPDOs as a real-world intervention that can be scaled across the Southern US. Project activities will be delivered by an interdisciplinary team – advised by an external advisory panel and established community advisory council, and implemented across six counties in North Carolina, a southern region where HIV incidence is high— Cumberland, Durham, Forsyth, Guilford, Mecklenburg, and Wake counties. At the conclusion of the funded project, we will have rigorously evaluated the intervention ready for scale-up across the US south that has potential to significantly advance EHE goals, specifically for Black cisgender women, an invisible population in HIV prevention.