"Sisters Influencing Sisters:" Findings from a Community-Engaged Process to Develop a Social Media-Based, Influencer-Delivered Intervention to Increase PrEP Awareness, Knowledge, and Uptake Among Transgender Women.

Transgender women (TW) shoulder a disproportionate burden of HIV diagnoses, yet are less likely to use PrEP, due to intersectional social and structural barriers to accessing services. TW utilize social media to share health information and foster community, yet to date, most studies leveraging the power of these platforms for PrEP interventions have focused on gay men. To address this gap, we partnered with TW social media influencers and engaged a Community Advisory Board (CAB) to develop an Instagram-based intervention to increase PrEP awareness, knowledge, and use among TW. Over quarterly meetings, surveys, and interviews, CAB members provided systematic input on intervention design. CAB guidance centered on three themes- leveraging platform functionality; maximizing representation and resonance, and fostering trust and credibility. In collaboration with the CAB, we shortlisted potential influencers and reviewed their accounts for reach, follower demographics, and content. We established paid partnerships with TW influencers (8) and held a 10-h virtual workshop to prepare them to be PrEP educators and navigators for their online followers. Before the funding for this research was interrupted by a NIMH termination letter, we developed the "Sisters" intervention to increase access to PrEP information delivered by TW influencers, foster dialogue around PrEP within online spaces, and provide Instagram-based linkage to vetted, gender affirming, HIV services. Partnering with community was essential to designing a social-media intervention tailored to considerations TW have around PrEP. This community-engaged, influencer-delivered model contributes new insights into digital public health design for marginalized populations.