PrEPwise Pilot Among Black Women in Eastern Virginia

Acceptability will be assessed using the client satisfaction survey (CSQ-8), an 8-item instrument with 4 possible responses for each item (1-4). Total scores range from 8 to 32; higher scores indicating greater satisfaction.

Acceptability will be assessed using the client satisfaction survey (CSQ-8), an 8-item instrument with 4 possible responses for each item (1-4). Total scores range from 8 to 32; higher scores indicating greater satisfaction.

Feasibility will be assessed though process measures including number of participants contacted, number screened for eligibility, number enrolled, and number lost to follow-up.

Fidelity will be assessed measured using a 10-item fidelity checklist, completed by participants after intervention delivery. Each item on the checklist indicates whether a specific component was delivered as expected (e.g., "The CHW discussed PrEP side effects with me") Items are scores as "yes=1" or "no=0". Total scores range from 0-10, with higher scores indicating higher fidelity to the intervention protocol.

PrEP initiation is defined as having at least one PrEP prescription fill during the 3-month period of the study using pharmacy fill data.

PrEP persistence is defined as the length of time that a person continued to refill PrEP prescription without an interruption of more than 30 days. PrEP persistence will be assessed using pharmacy refill data obtained at 3-month follow-up. Participants will be categorized as either PrEP-persistence (refilled prescription within 30 days of the previous fill running out) or PrEP non-persistent (gap of >30 days between refills). This binary outcome indicates whether participants maintained continuous PrEP coverage throughout the 3-month study period

Perceived HIV risk will be measured using the Centers for Disease Control (CDC) 5-item screening tool to determine PrEP eligibility for heterosexual women. Questions assess behavioral risk factors. These questions are: having a sexual partner who is HIV positive, having condomless sex with partners of unknown status, having a bacterial sexually transmitted infection (STI) in the past 6 months, exchanging sex for money or drugs, and injecting drugs. A "yes" response to any of these questions indicates a risk factor. Participants who respond to one or more items are considered at high HIV risk and meet CDC criteria for PrEP eligibility. Higher numbers indicate greater perceived HIV risk.

PrEP knowledge will be assessed using 13-item knowledge scale developed by Walsh et al. (2019). This scale measures knowledge about PrEP through true/false items covering topics including: what PrEP is, how it works, its effectiveness in preventing HIV, who should use, side effects, and how to access it. Items are scored as correct=1 or incorrect/don't know=0. Total scores range from 0 to 13, with higher scores indicating greater knowledge about PrEP.

PrEP attitudes will be assessed using 5-item attitudes scale developed by Walsh et al. (2019). This scale measures attitudes toward PrEP use including perceptions of effectiveness, safety, responsibility, adherence burden, and government safety assurance. Responses are rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Total scores re calculated by summing item responses, with higher scores indicating more positive attitudes toward PrEP.

PrEP stigma will be assessed using 5-item HIV PrEP Stigma scale developed by Walsh et al. (2020). This scale measures perceptions of stigma associated with PrEP use, including judgments about PrEP users, embarrassment about obtaining PrEP, and concerns about disclosure to friends, family, and sexual partners. Responses are rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5(strongly agree). Total scores range from 5-25, with higher scores indicating greater perceived PrEP stigma.

Decisional conflict will be assessed using the 16-item Decisional Conflict Scale (DCS) developed by O'Connor (1995). The scale measures uncertainty in decision-making across five subscales: uncertainty, feeling uninformed, unclear values, unsupported in decision-making, and ineffective decision-making. Items are rated on a 5-point Likert scale from 1 (strongly agree) to 5 (strongly disagree). Items are summed, divided by 16 then multiplied by 25. Score ranges from 0 (no decisional conflict) to 100 (extremely high decisional conflict).

Intersectional discrimination experiences. Intersectional discrimination will be assessed using the validated 31-item Intersectional Discrimination Index (InDI) developed by Scheim and Bauer (2019). The index consists of three subscales measuring: 1) anticipated discrimination (9 items), 2) day-to-day discrimination (9 items), and 3) major discrimination experiences (13 items). Participants rate frequency of discrimination experiences, with higher scores indicting greater experiences of discrimination.