Abstract
In Miami-Dade County, high HIV incidence rates and suboptimal uptake of HIV prevention strategies, such as pre-exposure prophylaxis (PrEP), underscore significant gaps in community HIV awareness and service accessibility. Novel interventions leveraging community-based participatory research (CBPR) and peer-driven distribution mechanisms offer potential solutions for increasing engagement with HIV testing and preventive services, yet few existing interventions are culturally tailored or systematically integrated into local contexts. This study aimed to develop and refine a culturally sensitive, peer-distributed at-home HIV self-test (HIVST) and prevention information intervention called Test-to-PrEP, to address specific needs within Miami-Dade's diverse populations.
A CBPR approach was employed, incorporating iterative community stakeholder engagement through a purposely selected, diverse 10-member advisory panel. Members included representatives from local HIV prevention organizations, academic experts, and community advocates reflecting key populations affected by HIV, notably Hispanic/Latino men who have sex with men (MSM), Black women, and immigrants. Development activities included structured weekly meetings, thematic analysis of qualitative panel discussions, and literature reviews to identify intervention gaps and opportunities for optimization. Materials were pretested among PrEP clients, incorporating feedback into intervention revisions. Training for intervention distributors utilized a standardized "Train-the-Trainer" module to promote fidelity and scalability.
Key outputs included the development of gender- and sexual orientation-neutral educational materials (a six-page prevention booklet and discreetly packaged self-test kits), a culturally and linguistically adapted data collection survey available via QR code, and refined training procedures emphasizing distributor preparedness and self-efficacy. Thematic analysis revealed critical community preferences for neutral and inclusive messaging, privacy considerations in materials packaging, and systematic distributor-recipient linkage to enhance traceability and accountability. Pilot feedback affirmed the perceived quality, cultural acceptability, and broad accessibility of the developed materials.
The CBPR-informed Test-to-PrEP intervention demonstrates an innovative, scalable model for improving accessibility and acceptability of HIV self-testing and prevention information in high-incidence communities. Results underscore the importance of inclusive, culturally sensitive intervention design, systematic training approaches, and rigorous community collaboration to optimize health services delivery. Future implementation studies are ongoing to quantitatively evaluate the intervention's effectiveness on HIV testing uptake, PrEP initiation, and subsequent clinical service utilization.