Encouraging Multiple PrEP Options for Women Engaged in PRimary Care (EMPOWER) - We will adapt and pilot test a technology-enabled, primary care-based, health literacy strategy to empower women with increased vulnerability to HIV to make informed decisions about PrEP. Nearly 20% of new HIV infections in the United States (US) occur among women; women with low health literacy are disproportionately affected. Pre-exposure prophylaxis (PrEP) is a safe, effective, and empowering option for HIV prevention women can initiate and use without partner negotiation. Yet most women are unaware PrEP is an option for them. With primary care representing the frontline of healthcare for most adult women, it is an ideal setting to promote PrEP awareness and informed decision-making. Importantly, women themselves have asked for PrEP discussions to be normalized in primary care and multiple studies have shown that women value talking with clinicians about PrEP. Unfortunately, many primary care providers lack the time, resources, and experience needed to counsel women on PrEP during busy, routine visits. Our proposed R34 Encouraging Multiple PrEP Options for Women Engaged in PRimary Care (EMPOWER) therefore offers a pragmatic and innovative approach to the delivery of PrEP information to women in primary care. The EMPOWER strategy addresses well-documented barriers and ‘missed opportunities’ for HIV prevention among women and supports informed PrEP decision-making by: 1) identifying women who may benefit most from PrEP via an electronic health record-based algorithm that utilizes available data on HIV risk factors; 2) delivering understandable, actionable, and non-stigmatizing PrEP education, in multiple formats and languages, directly and securely to women via the patient portal; 3) enabling women to discreetly self-schedule a visit to discuss PrEP options with either their own primary care provider or with a primary care providers who has years of experience in PrEP delivery; and 4) supporting provider counseling via clinical decision support that provides standardized, patient-centered language to guide PrEP discussions and ‘smart sets’ to facilitate PrEP prescribing, when desired. Our specific aims are to: 1) Adapt and coordinate the EMPOWER strategy to support informed decision-making among women with increased vulnerability to HIV seen in primary care; 2) Pilot test the efficacy of the EMPOWER strategy, compared to an attention control, on PrEP knowledge, stigma, and future intention to use PrEP; and 3) Assess the reach, adoption, implementation, and maintenance of EMPOWER components. EMPOWER will be evaluated in Cook County, an ‘Ending the HIV Epidemic’ priority area. The study will be meaningfully informed by an advisory board of women, a scientific advisory board of clinicians and experts, and another board of local organization leaders in the field of HIV.
