Acción PrEP: A Multi-Method Pilot Design to Assess the Feasibility of Community Co-Designed Implementation Strategies to Advance PrEP Uptake Among Latines in the U.S. South.

INTRODUCTION: Despite systemic inequities in pre-exposure prophylaxis (PrEP) uptake among Latines (a gender-inclusive term for people of Latin American descent, used to promote inclusivity and language justice), clinic-level implementation strategies addressing health equity-related PrEP barriers are underutilized. This multi-method study assessed the feasibility and acceptability of community-co-designed, equity-focused strategies to improve PrEP uptake among Latines in the Southern United States.

METHODS: Facilitated by a community-based organization (CBO)/academic partnership, a workgroup of local community and public health constituents with HIV/PrEP experience from Mecklenburg County, North Carolina, co-developed PrEP implementation strategies over 6 months (March-August 2023), using implementation mapping, human-centred design and participatory methods. The resulting strategies were pilot-tested at a federally qualified health centre and a non-profit community healthcare organization (March-August 2024). Process measures included quantitative implementation strategy fidelity and descriptive strategy modifications. Outcomes included: quantitative acceptability of the workgroup process (using exit surveys) and qualitative feasibility and acceptability of the implementation strategies (using 23 qualitative key informant interviews conducted October 2024-February 2025).

RESULTS: Ten exit surveys were collected from workgroup members, with 60% identifying as Latine and 40% with HIV lived experience. Members reported high satisfaction with workgroup activities. The workgroup developed three health equity-focused strategies: (1) a needs assessment; (2) blended implementation facilitation (weekly facilitation meetings between a CBO external facilitator and clinic-based internal facilitator); and (3) a bilingual, culturally tailored PrEP awareness mass media campaign. Process data indicated: 100% fidelity to the needs assessment, 88% average completion of facilitation meetings and delayed campaign dissemination. Adaptations included fewer facilitation meetings, increased leadership engagement and a sustainability planning workshop. Key informant interviews included six pilot implementers and 17 potential adopters. Notable themes centred on strategy feasibility (e.g. concrete/actionable feedback, staffing challenges impacted feasibility), acceptability (e.g. an approachable implementation team) and perceived strategy benefits (e.g. improved patient outreach and engagement).

CONCLUSIONS: The community co-design process and resulting strategies were generally acceptable and feasible. Study findings highlighted the need to balance rapid actionability with implementation timelines that ensure time for meaningful change. Future trials may test whether this approach to PrEP implementation improves PrEP uptake and sustainment for Latines and other underserved populations.