Project Summary
Transgender women (TW) are at significantly higher risk of getting HIV, yet research indicates they are less
likely to use pre exposure prophylaxis (PrEP) and continue to have misconceptions about its utility. Trans-
inclusive communication, delivered by trusted peers, is a potentially useful strategy to address this gap, but
reaching a large number of TW can be difficult. The SIS (Sisters Influencing Sisters) study will use
preliminary findings from a NIMH funded R21 that utilized commercial marketing techniques called perceptual
mapping and vector message modeling to develop and concept test TW specific PrEP messages. Using the
Gender Affirmation Framework and the EPIS Implementation Framework as guides, we propose to embed
these tested PrEP messages and materials in the SIS intervention and pilot it using TW social influencers (SIs)
via Instagram. Specific aims of the research are: Aim 1: Design a community-led, social-media based PrEP
messaging training for TW SIs. We will recruit a Community Advisory Board (CAB) who will consult on all
aspects of the study, including the development of an SI training and recruitment of SIs, tools/measures,
dissemination of findings, and input on a future trial. Aim 2: Refine PrEP messaging materials, design the SIS
intervention modules, and identify and train TW SIs. We will finalize PrEP messaging materials, engaging
trans artists to refine images and convert to social media formats. With the help of our CAB, we will identify and
engage SIs on social media from two intervention locations (San Francisco Bay, Philadelphia) and two
comparison locations (New York and Los Angeles). Intervention SIs will be trained on the SIS intervention
content as well as delivery of clinical referrals and resources to their communities. Aim 3: Aim 3: Pilot test the
SIS intervention to collect feasibility, acceptability, and preliminary efficacy data to inform a full trial. We
will implement standardized core components of the Instagram-based intervention, evaluate dissemination and
reach of the PrEP messages, and monitor and evaluate engagement with the materials. To assess promise of
efficacy, we will identify a cohort of 120 followers (80 intervention, 40 comparison) to complete baseline, mid and
end of intervention surveys to track changes and compare levels of PrEP knowledge and PrEP perceptions. We
will also pilot remote collection of hair samples to monitor PrEP uptake and use in a subsample of participants
(n=30; 5 each SI) and do in-depth intervention implementation evaluation. We expect that findings will
significantly contribute to our understanding of how to communicate with a diverse group of TW, how to leverage
social media as a powerful communication channel, and how to disseminate information to increase PrEP
awareness and uptake by addressing the unique HIV prevention needs and concerns of TW.
