A Nursing-Informed Group Model for HIV Prevention and PrEP Uptake - Despite significant advances in HIV prevention, women in Midwest Ending the HIV Epidemic (EHE) jurisdictions account for more than half of new HIV diagnoses, highlighting persistent gaps in the uptake and sustained use of pre-exposure prophylaxis (PrEP). Although PrEP is 99% effective at preventing HIV when taken as prescribed, its full potential in optimizing health for all populations in Midwestern cities such as Chicago, Detroit, and Indianapolis has not been realized, demonstrating the need for strategies that integrate biomedical advancements with daily life health considerations. Women face complex barriers that limit access to HIV prevention resources, stemming from financial hardship, and suboptimal conditions of daily life, including inadequate housing, employment instability, and limited access to services. Existing care pathways relying on standard education and referral rarely advance women from PrEP awareness to sustained PrEP use, as obstacles impede progression along this continuum, contributing to persistent HIV differences. Therefore, innovative, theory-driven PrEP interventions are needed for women in EHE jurisdictions. Guided by NINR’s commitment to pioneering research to address persistent health challenges, our nurse-developed responsive PrEP intervention creatively connects women to care through meaningful community partnerships and seamless health transitions. Unlike traditional approaches, our three-session group intervention is tailored to improve PrEP uptake among women and more effectively supports their movement through the transtheoretical stages, from contemplation and preparation through to action and maintenance. Preliminary data from Chicago show this intervention is feasible and acceptable, supporting the proposed pragmatic trial. This hybrid type 2 site-randomized, cluster wait-list controlled trial among 300 women across six community sites is guided by the Exploration, Preparation, Implementation, and Sustainment framework. Aim 1 will assess the determinants, outcomes, and sustainability of P4BL implementation using a mixed-methods approach to inform a scalable toolkit for community-based organizations across the EHE. Aim 2 will assess the clinical effectiveness of P4BL compared to standard care education and referral, with primary outcomes of PrEP uptake at 4 weeks and secondary outcomes of HIV testing, care linkage, and progression along the PrEP continuum (secondary outcomes) at 3 months. This research will produce actionable, scalable strategies to reduce HIV incidence and, by improving PrEP engagement and retention, address gaps for women not well served by traditional approaches. By advancing innovative solutions tailored to real-world settings, this study is well-positioned to accelerate progress toward the EHE goal of a 90% reduction in new HIV infections by 2030, with implications for addressing preventive care gaps and advancing community-partnered HIV prevention.
