Effectiveness of a culturally tailored HIV Prevention intervention in promoting PrEP among Black women in community supervision programs in New York City: a randomized clinical trial


BACKGROUND: In the U.S. there is a significant racial and gender disparity in the uptake of pre-exposure prophylaxis (PrEP).Despite Black cisgender women experiencing a disproportionate burden of HIV acquisition, they are four times less likely to have initiated PrEP than their non-Hispanic white women. Few PrEP uptake interventions focus on cisgender women, and none have targeted women in community supervision programs (CSPs), which predominately serves Black women.Advancing an effective PrEP intervention for Black women in CSPs holds great promise for reducing inequities in PrEP uptake and increasing HIV prevention among this vulnerable group.
METHODS: We conducted a randomized clinical trial among 352 eligible Black women recruited from CSPs in NYC (probation, parole, alternative-to-incarceration programs) with a recent history of drug use. Participants were randomized to either E-WORTH (N=172) or an HIV testing control (N=180). E-WORTH participants received a 5-session, culturally-tailored, group-based HIV prevention intervention plus HIV testing; Control participants received HIV testing alone. Both conditions were delivered by Black female staff at a large CSP. We evaluated the effectiveness of the E-WORTH intervention on increasing awareness, intention and use of PrEP. Primary outcomes included: awareness of PrEP as a biomedical HIV prevention strategy, willingness to use PrEP and PrEP use over the prior 12-month period.
RESULTS: A total of 336 participants women tested HIV negative at baseline and therefore were considered PrEP-eligible and included in this sample.Compared to control participants, E-WORTH participants had significantly greater odds of being aware of PrEP as a biomedical HIV prevention strategy (AOR=3.25, 95% CI=2.01- 5.25, p<.001) and indicating a willingness to use PrEP(b= 0.19, 95% CI=0.001-0.38, p=.049). No significant difference between conditions was found with respect to PrEP use, which was low in both conditions.
CONCLUSIONS: These findings suggest the effectiveness of a culturally-tailored intervention for Black women in CSP settings in increasing awareness, willingness, and intention to initiate PrEP. The low uptake of PrEP in both arms may be due to lack of access, but also may highlight the need for providing more robust PrEP-on-demand strategies (e.g., PrEP telemedicine) during the intervention rather than linkage to a PrEP provider.