PrEPárate: Evaluation of a Community-Driven PrEP Social Marketing Intervention Tailored to Latina/o/x Individuals

PrEPárate: Evaluation of a Community-Driven PrEP Social Marketing Intervention Tailored to Latina/o/x Individuals | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article PrEPárate: Evaluation of a Community-Driven PrEP Social Marketing Intervention Tailored to Latina/o/x Individuals Harita S. Shah, Pedro A. Serrano, Priya K. Mathur, Ricardo Albarran, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3682611/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Latina/o/x sexual minority men (SMM) and transgender women (TW) remain disproportionately impacted by HIV, with higher HIV incidence and lower uptake of pre-exposure prophylaxis (PrEP) than non-Hispanic white peers. Disparities in PrEP uptake among Latina/o/x populations have been found to be due to structural, social, and personal barriers. Social marketing interventions have been shown to effectively address barriers and increase PrEP uptake in other populations, and thus offer potential as a tool to increase PrEP uptake for Latina/o/x populations. Methods : The PrEPárate campaign was developed through community based participatory research and ran from April to September 2022 in Cook County, Illinois. We conducted a mixed methods evaluation through surveys (N=515) and semi-structured interviews with community partners and survey participants (N=14). Cross-sectional associations of campaign exposure with PrEP awareness and uptake were examined in covariate-adjusted multivariable regression models. We used rapid qualitative methods to analyze interviews and assess implementation outcomes using the RE-AIM framework. Results : The campaign reached over 118,000 people on social media, with additional reach over public transit. PrEPárate exposure was associated with increased PrEP awareness (aOR= 5.23; 95% CI = (2.58, 10.63) and PrEP uptake (aOR= 1.69; 95% CI = (1.09, 2.62). Qualitative analysis found the campaign to be acceptable, appropriate, and implemented with fidelity. Future directions for PrEPárate include expanding adoption and focusing on PrEP stigma reduction. Conclusions : Social marketing campaigns can be an effective strategy to increase PrEP awareness and uptake among underserved Latina/o/x populations. Community engagement is essential to the development of tailored, acceptable, and appropriate interventions. PrEP Latino social marketing HIV prevention community Figures Figure 1 Figure 2 Introduction Latina/o/x sexual minority men (SMM) and transgender women (TW) remain disproportionately impacted by HIV, despite tremendous strides in HIV prevention and treatment in the United States. In 2021, Latina/o/x individuals represented approximately 18% of the U.S. population but accounted for 29% of the 32,100 new HIV diagnoses, primarily in individuals characterized as SMM [ 1 ]. Latina TW also had a significantly higher HIV incidence relative to White TW [ 2 ]. The HIV incidence rate for Hispanic/Latino persons in 2021 was 4 times the rate for White persons [ 1 ]. Following national trends, Latina/o/x SMM and TW in Chicago, IL face disproportionately higher HIV incidence rates than their non-Hispanic White peers [ 3 ]. Cook County, IL (including Chicago) is one of seven jurisdictions identified as driving the HIV epidemic among Latina/o/x populations [ 4 , 5 ]. Pre-exposure prophylaxis (PrEP) is a safe and effective means of biomedical HIV prevention [ 6 , 7 ]. Although use of PrEP has increased overall, uptake among minority communities has lagged behind [ 8 ]. The Centers for Disease Control and Prevention (CDC) reported in 2019 that the highest percentage of PrEP coverage was for White persons (63.3%), followed by Hispanic or Latino persons (14%), and Black or African American persons (8.2%) [ 1 ]. Recent research concerning racial/ethnic and sexual identity differences in PrEP uptake in Chicago indicated PrEP-eligible Latina/o/x men were less likely to receive a PrEP prescription than their White peers [ 9 ]. Through the lens of intersectionality, Latina/o/x SMM and TW experience intersecting forms of social marginalization (e.g. racism, heterosexism, cisgenderism) that create multilevel barriers to care engagement [ 10 , 11 ]. Barriers to PrEP uptake among Latina/o/x SMM and TW include structural (e.g., lack of insurance, structural racism), community (e.g., PrEP prejudice, sexual stereotypes) and individual factors (e.g., mistrust, fear of side effects) [ 12 – 16 ]. Structural barriers to PrEP use by Latina/o/x populations often include lack of health insurance, language discordance, limited health literacy, and immigration status [ 8 ]. At the community level, Latina/o/x SMM and TW are often dissuaded by peers or romantic partners from taking PrEP to avoid the stigma of being labeled as sexually irresponsible, promiscuous, or immoral [ 15 ]. On an individual level, common barriers to PrEP uptake among Latina/o/x SMM and TW include medical mistrust, wariness of side effects, and lack of awareness [ 16 ]. Prior studies have shown significantly lower rates of awareness among Latina/o/x individuals with limited English proficiency (LEP) in comparison to their non-Latina/o/x peers [ 8 , 12 , 16 – 18 ]. In studies of PrEP interest and acceptability, while awareness was initially low, once aware of PrEP, Latina/o/x SMM reported willingness to adopt PrEP at the same or higher levels than non-Latina/o/x SMM [ 17 , 19 ]. Given the disproportionate burden of the HIV epidemic and lack of PrEP awareness among Latina/o/x SMM and TW, there is an urgent need to identify effective, tailored interventions to increase PrEP awareness and uptake in these populations [ 4 , 5 , 20 ]. Moreover, it is critical that PrEP interventions for Latina/o/x SMM and TW utilize community-based participatory research (CBPR) approaches to understand and synchronously address multilevel, intersectional barriers to PrEP uptake and retention [ 4 , 8 , 19 ]. CBPR is a collaborative approach that equitably involves community partners throughout the research process, facilitating empowerment of marginalized populations as well as optimizing translation and sustainability of HIV interventions [ 21 , 22 ]. Social marketing interventions are an effective means of improving HIV testing among Latina/o/x SMM and TW and thus offer tremendous potential as a tool to promote PrEP [ 18 , 23 – 25 ]. Social marketing involves the application of commercial marketing principles to design and implement programs to affect health behavior change, often through social media and offline advertisements [ 26 ]. PrEP social marketing campaigns have raised awareness and uptake of PrEP in other populations, but few have been tailored to Latina/o/x SMM and TW. Among Black SMM and TW in Chicago, exposure to the PrEP4Love social marketing campaign was associated with increased PrEP awareness and 87% higher utilization of PrEP [ 27 , 28 ]. In other settings, some PrEP campaigns have been developed for Black and Latina/o/x SMM jointly; however, these groups have distinct cultural differences and they may be better served by separately tailored interventions [ 20 , 28 – 32 ]. Latina TW are notably underrepresented in PrEP intervention research [ 8 , 33 , 34 ]. Of the limited PrEP social marketing interventions that include Latina/o/x SMM or TW, few evaluated clinical outcomes such as PrEP uptake [ 29 , 30 , 33 , 35 ]. We created the PrEPárate social marketing intervention through partnerships between the Chicago Queer Latinx (CQL) Collaborative and investigators at the University of Chicago, Northwestern University, and Cook County Health. The CQL Collaborative is a group of 10 Latina/o/x and LGBTQ + stakeholders representing community-based organizations (CBOs) that provide HIV services to Latina/o/x individuals. Following the principles of CBPR, these community stakeholders were partners in all stages of the project’s development, implementation, and evaluation [ 36 ]. We adapted the PrEP4Love campaign for a Latina/o/x audience through focus groups, surveys, and crowdsourcing over social media [ 36 ]. Local Latina/o/x artists created the content, which featured recognizable Chicago-based Latina/o/x campaign ambassadors (Fig. 1 ). Paid advertisements were distributed on Facebook, Instagram, YouTube, Grindr, and social media pages of Latina/o/x health focused community-based organizations. Physical content included posters, flyers, Chicago Transit Authority bus and train advertisements (Fig. 2 ), and giveaway items at community events. Advertisements directed people to the PrEPárate website which featured PrEP information in English and Spanish, and options to access PrEP online or through the HIV Resource HUB bilingual hotline [ 37 ]. The PrEPárate social marketing intervention ran from April 2022 to September 2022. Methods We evaluated the PrEPárate social marketing intervention using a mixed methods approach, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework [ 38 , 39 ]. Social media metrics of reach are published elsewhere [ 36 ]. In its first year, PrEPárate reached over 118,750 people on social media with additional reach at community events and over Chicago public transit advertisements. Surveys We conducted cross-sectional surveys between November 2022 and June 2023 to evaluate campaign reach and effectiveness. Eligible participants self-identified as Hispanic or Latina/o/x, 18 years of age or older, and living in Cook County, IL. Online recruitment entailed distribution of a Qualtrics link over Chicago Latina/o/x-centric social media groups, followed by an option to share with peers upon survey completion. In-person recruitment occurred at community events, Latina/o/x-focused health centers, bars, and consulates. Surveys were available in English and Spanish and assessed socio-demographics, exposure to the PrEPárate campaign, if and how the PrEPárate campaign impacted them, and primary outcomes of PrEP awareness and PrEP uptake. Survey respondents were offered a $ 15 gift card for their participation.This project was deemed exempt by the University of Chicago Institutional Review Board because it involved surveys and interviews with no more than minimal risk to participants. PrEP Awareness We assessed exposure to PrEPárate by asking if respondents had seen or heard of the PrEPárate campaign, with a color logo to minimize confusion with other campaigns. PrEP awareness was measured by asking, “What is your experience with PrEP (pre-exposure prophylaxis) as of today?” with options of “I have never heard of PrEP,” “I have heard of PrEP but have not taken it,” “I have been on PrEP before but not currently,” or “I am currently on PrEP.” Responses of “I have never heard of PrEP” were categorized as “Not Aware” of PrEP, and any of the other responses to this question were categorized as “Aware” of PrEP. PrEP Uptake Surveys also included the Motivational PrEP Cascade to assess for potential impact at different stages of behavior change [ 40 ]. The Motivational PrEP Cascade is based on the Transtheoretical Model of Change to assess behavior change in the context of PrEP decision making over time, with the fourth stage being PrEP uptake [ 41 ]. We included survey questions that assessed for four stages of the Motivational PrEP Cascade: (1) PrEP Precontemplation, individuals who are unwilling to take PrEP or do not believe they are appropriate candidates; (2) PrEP Contemplation, individuals who are willing to initiate PrEP and self-identify as an appropriate candidate; (3) PrEParation, individuals who are planning to initiate PrEP; (4) PrEP Action & Initiation, individuals who have spoken with a provider and initiated PrEP. Qualitative Interviews We conducted 14 total semi-structured interviews. We interviewed Latina/o/x SMM and TW community members to assess campaign effectiveness, appropriateness and acceptability until reaching thematic saturation [ 38 ]. Interviewees were selected using a random number generator to select from survey respondents who marked their interest. Interview topics included PrEP awareness, PrEPárate exposure, appropriateness and acceptability, and future directions for similar work. Adoption, implementation, and maintenance were evaluated through semi-structured interviews with CQL Collaborative members. All collaborative members were invited to participate. All interviews were conducted over Zoom with audio recordings and transcribed using Otter.ai. Transcripts were cleaned by a trained bilingual research assistant. Data Analysis: Surveys We compared socio-demographics between respondents with and without PrEPárate exposure using chi-squared analyses. We examined associations between PrEPárate exposure and the primary outcomes of PrEP awareness and PrEP uptake (stage 4 of the Motivational PrEP Cascade) using binary and ordinal logistic regression, respectively. People were identified as SMM if they self-reported male gender and sexual orientation as gay, bisexual, or queer. Variables included in the multivariable models were identified through univariate analyses and were consistent with prior literature. Covariates in the PrEP awareness analysis included age, education level, English proficiency, primary care access, and sexual orientation. Covariates in the PrEP uptake analysis included age, education level, English proficiency, sexual orientation, and number of sexual partners in the last three months. Insurance status, race, health literacy, survey language, and transgender status were other variables considered for both models, but they were ultimately not selected and not significant on univariable analysis. All analyses were conducted in STATA version 18 [ 42 ]. Qualitative Interviews Qualitative interview data were analyzed using rapid qualitative methods, which has been shown to be an effective strategy for timely results in implementation science [ 43 ]. Each transcript was independently reviewed by 2 team members trained in rapid qualitative methods. Key points and quotes were included in a templated summary document. The templated summary documents were then moved to a matrix to identify key themes. Discrepancies were resolved through weekly meetings where expert qualitative analysts discussed data deviances and result issues to achieve consensus. Results Quantitative Results 515 survey responses were collected between November 1, 2022, and June 30, 2023. Participant demographics and the primary outcomes of PrEP awareness and PrEP uptake are presented in Table 1 . Most survey respondents were age 18–34 years (n = 374, 72.6%) and completed the survey in English (n = 356, 69.1%) versus Spanish (n = 159, 30.9%). 30.7% (n = 158) identified as sexual minority men (SMM). 3.1% (n = 16) identified as transgender women and 6.8% (n = 35) identified as non-binary. In terms of PrEPárate exposure, 31.5% (n = 162) reported having seen or heard of the PrEPárate social marketing intervention. When asked if and how the PrEPárate intervention affected those exposed, 42.0% (n = 66) said they learned about PrEP and HIV prevention, 34.4% (n = 54) said it provided information on how to access PrEP, 15.3% (n = 24) said it influenced them to start PrEP, and 3.8% (n = 6) found a PrEP provider. 82.8% (n = 130) said it impacted them in at least one way, with only 17.2% (n = 27) reporting no impact. Table 1 Survey Respondent Demographics by PrEPárate Campaign Exposure Total N = 515 No PrEPárate Exposure (N, %) N = 353 PrEPárate Exposure (N, %) N = 162 P-value Age Categories 0.250 18–24 81 (22.9) 42 (25.9) 25–34 165 (46.7) 86 (53.1) 35–44 56 (15.9) 16 (9.9) 45+ 50 (14.2) 18 (11.1) Race 0.240 Native American or Alaskan Native 22 (6.2) 18 (11.1) Black or African American 14 (4.0) 10 (6.2) Asian 2 (0.6) 2 (1.2) Native Hawaiian or Pacific Islander 1 (0.3) 1 (0.6) White 100 (28.3) 50 (30.9) Other 122 (34.6) 45 (27.8) Did not answer 92 (26.1) 36 (22.2) Gender and Transgender Status 0.005 Cisgender Men 174 (55.2) 73 (51.0) Cisgender Women 111 (35.2) 38 (26.6) Nonbinary 17 (5.4) 18 (12.6) Transgender Men 6 (1.9) 5 (3.5) Transgender Women 7 (2.2) 9 (6.3) Sexual Orientation < 0.001 Heterosexual 136 (38.5) 27 (16.7) Bisexual 38 (10.8) 23 (14.2) Gay 85 (24.1) 59 (36.4) Lesbian 8 (2.3) 3 (1.9) Queer 21 (5.9) 29 (17.9) Other 55 (15.6) 19 (11.7) Sexual Minority Men (SMM) 96 (27.7) 62 (38.8) 0.013 Education 0.640 Less than high school 43 (12.2) 14 (8.6) Completed high school 189 (53.5) 92 (56.8) Bachelor’s degree 80 (22.7) 34 (21.0) Advanced degree 40 (11.3) 22 (13.6) HIV Status < 0.001 Positive 20 (5.7) 18 (11.2) Negative 236 (67.4) 125 (78.1) Never been tested 94 (26.9) 17 (10.6) Health Literacy Level 0.004 High 258 (73.7) 138 (85.2) Low 92 (26.3) 24 (14.8) English Proficiency Status < 0.001 English Proficient 219 (62.2) 125 (77.6) Somewhat English Proficient 51 (14.5) 24 (14.9) Limited English Proficiency 82 (23.3) 12 (7.5) Type of Insurance < 0.001 None 94 (29.5) 23 (14.9) Medicare 53 (16.6) 42 (27.3) Medicaid 40 (12.5) 11 (7.1) Private 132 (41.4) 78 (50.6) PrEP Awareness < 0.001 Not Aware 155 (47.8) 20 (13.0) Aware 169 (52.2) 134 (87.0) PrEP Motivational Cascade Stage < 0.001 1 (PrEP Pre-Contemplation) 95 (34.5) 25 (19.5) 2 (PrEP Contemplation) 100 (36.4) 37 (28.9) 3 (PrEParation) 55 (20.0) 34 (26.6) 4 (PrEP Action and Initiation) 25 (9.1) 32 (25.0) PrEP Experience < 0.001 Never used PrEP 155 (47.8) 20 (13.0) Previously on PrEP 140 (43.2) 102 (66.2) Currently on PrEP 29 (9.0) 32 (20.8) PrEP awareness People who were exposed to PrEPárate had a higher odds of PrEP awareness relative to people who were not exposed to PrEPárate (Table 2 ), adjusting for age, education, LEP, primary care access, and sexual orientation. People who saw PrEPárate were about five times more likely than people who did not see PrEPárate to be aware of PrEP. Table 2 Association between PrEPárate Exposure and PrEP Awareness in Various Models Total N = 515 Unadjusted Model N = 478 Adjusted Model a N = 363 Aware of PrEP (N, row %) Unaware of PrEP (N, row %) OR of PrEP Awareness (95% CI) aOR of PrEP Awareness (95% CI) Exposed to PrEPárate 134 (87.0) 20 (13.0) 6.14** (3.66, 10.31) 5.23** (2.58, 10.63) Not Exposed to PrEPárate 169 (52.2) 155 (47.8) 1 (reference) 1 (reference) a Adjusted Model: Adjusted for age, education, limited English proficiency, primary care access, and sexual orientation. **Statistically significant p < 0.001 PrEP Uptake The association of PrEPárate campaign exposure with PrEP uptake was measured through ordered logistic regression given the PrEP Motivation Cascade consists of four unique ordered stages, with PrEP uptake being the final stage [ 35 ]. The odd ratios obtained from ordered logistic regression express the odds of participants being in stage 4 (PrEP uptake) relative to stages 1 through 3. People exposed to the PrEPárate campaign had a higher odds of PrEP uptake relative to people not exposed to PrEPárate (aOR: 1.69 95% CI: 1.09, 2.62), adjusting for age, education, limited English proficiency, sexual orientation, and number of sexual partners in the last three months (Table 3 ). Table 3 Association Between PrEPárate Exposure and PrEP Uptake Total N = 515 Unadjusted Model N = 403 Adjusted Model a N = 373 Stages 1–3 (N, row %) Stage 4: PrEP Uptake (N, row %) OR of PrEP Uptake (95% CI) aOR of PrEP Uptake (95% CI) Exposed to PrEPárate 96 (75.0) 32 (25.0) 2.58** (1.74, 3.81) 1.69* (1.09, 2.62) Not Exposed to PrEPárate 250 (90.9) 25 (9.1) 1 (reference) 1 (reference) a Adjusted model: Adjusted for age, education, limited English proficiency, sexual orientation, and number of sexual partners in the last three months. *Statistically significant p < 0.05 **Statistically significant p < 0.001 Qualitative Results A total of 14 interviews were completed to assess implementation outcomes following the RE-AIM framework. We conducted interviews with seven SMM and TW community members to assess intervention effectiveness. Community members had a median age of 27 years, were English proficient, had completed high school, and identified as SMM (n = 5), as a transgender woman (n = 1) or as transgender non-binary (n = 1). Seven CQL Collaborative members participated in interviews assessing the adoption, implementation, and maintenance of the intervention. Effectiveness SMM and TW community members interviewed found PrEPárate to be acceptable and appropriate. Community members felt the campaign was appropriate for queer and bilingual Latina/o/x audiences because of the playful colors, incorporation of Spanish language, and diverse representation of ambassadors in campaign materials. Community members liked the PrEPárate logo and design because it felt representative of Latina/o/x communities. They recalled seeing PrEPárate on CTA advertisements, social media, YouTube, and Grindr ads. Some participants wished for greater representation of Black Latina/o/x individuals, older individuals, and people assigned female at birth. Community members overall felt the campaign was impactful. They discussed that PrEPárate impacted them in different ways: considering if PrEP was right for them, serving as a tool they recommended to others, and affecting the younger generation’s awareness and access to PrEP. "By giving it that bright color, the pop of life, the celebratory feel, we're reframing people's perspectives…this doesn't have to be a bad thing, protection and health and advocating for myself doesn't have to be something that has to be traumatic.” -Community Member Interview Adoption CQL Collaborative partners noted that Latina/o/x-based community organizations adopted materials, especially if the CBO was represented by a person in the CQL Collaborative. A barrier to adoption of the campaign was delays in distribution of grant funding. Once CBOs adopted the campaign materials, they found materials to be effective conversation starters at tabling events or with CBO clients. Social media was also an important facilitator for adoption by community groups. Implementation When developing PrEPárate, CQL Collaborative partners felt heard and thought the community artists accurately captured the project vision. Barriers to campaign development included funding and administrative delays. Once PrEPárate launched, the name of the campaign and the featuring of identifiable local ambassadors were effective in engaging members of the public. CQL Collaborative partners believed that the combination of advertising on the CTA and social media was effective, and suggested more in-person outreach in the future to more effectively reach marginalized populations. They noted that all of the ambassadors were young adults and would have liked to see diversity in age, including older adults, be highlighted in the campaign. Despite this, the campaign was well received at community events by different generations. “We did the thing that we set out to do, right, of like creating a social media campaign that was about engaging Latinos in this conversation around PrEP.” – CQL Collaborative Member Interview Maintenance To maintain PrEPárate, CQL Collaborative partners expressed the need for ongoing funding to continue and expand marketing efforts. Potential barriers identified included the political climate, social media limits on targeting and advertising, and uncertainty that the intervention could reach highly marginalized populations. CQL Collaborative partners were excited about opportunities to build on or expand the campaign. Future iterations of the campaign could include local Latina/o/x community centers such as libraries, shops, and churches to expand reach beyond SMM and TW. They discussed tailoring the campaign to certain groups such as older Spanish-speaking immigrants and addressing social determinants of health that affect PrEP uptake such as mental health, substance use, or employment. CQL Collaborative partners also expressed interest in adapting and expanding PrEPárate for other populations across the United States. Discussion PrEPárate is one of the first PrEP social marketing interventions tailored specifically to Latina/o/x SMM and TW. Exposure to PrEPárate was significantly associated with increased PrEP awareness and PrEP use, suggesting that culturally-responsive social marketing interventions may be an effective means of addressing PrEP disparities. The qualitative evaluation showed that PrEPárate was developed and implemented with fidelity and was well received by the target audience. By combining social marketing with community engagement, PrEPárate achieved a wide reach while simultaneously addressing common barriers to care. Among the few PrEP social marketing interventions tailored to Latina/o/x populations, even fewer have assessed clinically relevant outcomes such as PrEP awareness and uptake. Our results support findings from social marketing studies in Black populations and diverse populations which found increases in PrEP awareness and uptake [ 30 , 44 ]. PrEPárate was adapted from PrEP4Love, a PrEP-focused social marketing campaign in Chicago tailored to Black populations, in which individuals who had seen PrEP4Love ads were more likely to have taken PrEP in the last six months [ 27 ]. Similarly, our findings showed higher odds of PrEP uptake in Latina/o/x individuals who had seen PrEPárate. We believe that providing multiple options for PrEP access, beyond promoting awareness alone, was essential to facilitating PrEP uptake. Community engagement with local Latina/o/x community members and CBOs was essential to producing an intervention that resonated with local Latina/o/x individuals. Several prior PrEP social marketing interventions have been broadly marketed to people of color, or jointly to Black and Latina/o/x gender and sexual minority individuals [ 20 ]. Multiply-marginalized populations such as Black and Latina/o/x LGBTQ + individuals have unique histories and intersectional identities that can often be better served by culturally responsive, tailored interventions [ 28 – 32 ]. We found that using a range of community engagement strategies including focus groups, interviews, a crowdsourcing contest, contracting local artists and designers to create the campaign, shared ownership with the CQL Collaborative, and feedback from local Latina/o/x youth and adult advisors allowed for greater community input and empowerment [ 36 ]. The results of this work - the PrEPárate campaign name, vibrant colors, and relatable ambassadors - were found to be key to engaging members of the Latina/o/x community. Featuring local campaign ambassadors encouraged Latina/o/x SMM and TW to consider PrEP by highlighting the positive experiences of trusted community members. Our study had multiple limitations. One inherent limitation of this pilot project was the cross-sectional nature of the evaluation. It is possible that some of the effect could be explained by the intervention preferentially reaching younger SMM and TW with higher education and greater baseline exposure to PrEP. Future research should explore these findings through rigorous longitudinal or randomized design. A second limitation was the time between the intervention and the evaluation. Due to administrative and funding delays, surveys and interviews were conducted up to 9 months after the end of the campaign. This delay may have reduced campaign recall, though it is encouraging that for some people exposed, the campaign was memorable even months later. Finally, a nonrandom sample of survey participants was used, as we partnered with local organizations to recruit an adequate sample of SMM and TW. Participants recruited through HIV-focused CBOs may have been more experienced with HIV prevention. The SMM and TW interviewees were also survey participants who consented to an interview and may have been subject to selection bias. Thus, this evaluation may not have reached individuals who are not well connected to Latina/o/x community-based organizations, community events, or social media. Future interventions and evaluation should include dedicated outreach to highly marginalized Latina/o/x populations. Ultimately, community-driven PrEP social marketing campaigns tailored to Latina/o/x populations may be a promising means of increasing PrEP awareness and uptake among Latina/o/x populations. Promoting awareness while simultaneously addressing barriers to PrEP access is key to reducing disparities along the PrEP care continuum. The impact of PrEPárate was only possible through strong community partnerships in the development, implementation, and evaluation of the campaign. Future directions for research based on our qualitative evaluation include addressing PrEP stigma, dedicated outreach to individuals with LEP, and multi-level interventions to address mental health needs and social determinants of health that impact HIV vulnerability within Latina/o/x communities. Declarations The authors have no relevant financial or non-financial interests to disclose. References Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2019. HIV Surveillance Supplemental Report 2021;26(No.2). http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published May 2021. Accessed 16 Nov 2023. Centers for Disease Control and Prevention. 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Community member perspectives from transgender women and men who have sex with men on pre-exposure prophylaxis as an HIV prevention strategy: implications for implementation. Implement Sci . 2012;7:116. doi:10.1186/1748-5908-7-116 Dolezal C, Frasca T, Giguere R, et al. Awareness of Post-Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP) Is Low but Interest Is High Among Men Engaging in Condomless Anal Sex With Men in Boston, Pittsburgh, and San Juan. AIDS Educ Prev . 2015;27(4):289-297. doi:10.1521/aeap.2015.27.4.289 Shah HS, Grieb SMD, Flores-Miller A, et al. Sólo Se Vive Una Vez: Evaluation of a Social Marketing Campaign Promoting HIV Screening and Prevention for Immigrant Latinxs. AIDS Behav . 2021;25(9):3024-3033. doi:10.1007/s10461-021-03165-4 Cohen SE, Vittinghoff E, Bacon O, et al. High interest in preexposure prophylaxis among men who have sex with men at risk for HIV infection: baseline data from the US PrEP demonstration project. J Acquir Immune Defic Syndr . 2015;68(4):439-448. doi:10.1097/QAI.0000000000000479 Rodriguez-Diaz CE, Martinez O, Bland S, Crowley JS. Ending the HIV epidemic in US Latinx sexual and gender minorities. Lancet . 2021;397(10279):1043-1045. doi:10.1016/S0140-6736(20)32521-6 Kellogg Foundation. Community-based public health initiative. Rhodes SD, Malow RM, Jolly C. Community-based participatory research: a new and not-so-new approach to HIV/AIDS prevention, care, and treatment. AIDS Educ Prev . 2010;22(3):173-183. doi:10.1521/aeap.2010.22.3.173 Olshefsky AM, Zive MM, Scolari R, Zuñiga M. Promoting HIV risk awareness and testing in Latinos living on the U.S.-Mexico border: the Tú No Me Conoces social marketing campaign. AIDS Educ Prev . 2007;19(5):422-435. doi:10.1521/aeap.2007.19.5.422 Shah HS, Dolwick Grieb SM, Flores-Miller A, Greenbaum A, Castellanos-Aguirre J, Page KR. Sólo Se Vive Una Vez: The Implementation and Reach of an HIV Screening Campaign for Latinx Immigrants. AIDS Educ Prev . 2020;32(3):229-242. doi:10.1521/aeap.2020.32.3.229 Solorio R, Norton-Shelpuk P, Forehand M, et al. Tu Amigo Pepe: Evaluation of a Multi-media Marketing Campaign that Targets Young Latino Immigrant MSM with HIV Testing Messages. AIDS Behav . 2016;20(9):1973-1988. doi:10.1007/s10461-015-1277-6 Andreasen AR. Marketing Social Change: Changing Behavior to Promote Health, Social Development, and the Environment . Jossey-Bass; 1995. Dehlin JM, Stillwagon R, Pickett J, Keene L, Schneider JA. #PrEP4Love: An Evaluation of a Sex-Positive HIV Prevention Campaign. JMIR Public Health Surveill . 2019;5(2):e12822. doi:10.2196/12822 Phillips G, Raman AB, Felt D, et al. PrEP4Love: The Role of Messaging and Prevention Advocacy in PrEP Attitudes, Perceptions, and Uptake Among YMSM and Transgender Women. J Acquir Immune Defic Syndr . 2020;83(5):450-456. doi:10.1097/QAI.0000000000002297 Kudrati SZ, Hayashi K, Taggart T. Social Media & PrEP: A Systematic Review of Social Media Campaigns to Increase PrEP Awareness & Uptake Among Young Black and Latinx MSM and Women. AIDS Behav . 2021;25(12):4225-4234. doi:10.1007/s10461-021-03287-9 Marshall B, Salabarría-Peña Y, Johnson W, Moore L. Reaching racial/ethnic and sexual and gender minorities with HIV prevention information via social marketing. Eval Program Plann . 2022;90:101982. doi:10.1016/j.evalprogplan.2021.101982 Patel VV, Ginsburg Z, Golub SA, et al. Empowering With PrEP (E-PrEP), a Peer-Led Social Media-Based Intervention to Facilitate HIV Preexposure Prophylaxis Adoption Among Young Black and Latinx Gay and Bisexual Men: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc . 2018;7(8):e11375. doi:10.2196/11375 Nakelsky S, Moore L, Garland WH. Using evaluation to enhance a pre-exposure prophylaxis (PrEP) social marketing campaign in real time in Los Angeles County, California. Eval Program Plann . 2022;90:101988. doi:10.1016/j.evalprogplan.2021.101988 Rhodes SD, Kuhns LM, Alexander J, et al. Evaluating Locally Developed Interventions to Promote PrEP Among Racially/Ethnically Diverse Transgender Women in the United States: A Unique CDC Initiative. AIDS Educ Prev . 2021;33(4):345-360. doi:10.1521/aeap.2021.33.4.345 Sevelius JM, Glidden DV, Deutsch M, et al. Uptake, Retention, and Adherence to Pre-exposure Prophylaxis (PrEP) in TRIUMPH: A Peer-Led PrEP Demonstration Project for Transgender Communities in Oakland and Sacramento, California. J Acquir Immune Defic Syndr . 2021;88(1):S27-S38. doi:10.1097/QAI.0000000000002808 Dehlin JM, Issema R, Eavou R, et al. The Motivational PrEP Cascade Guides Interpretation of Early PrEP Linkage to Care for Young Black Men Who Have Sex With Men: The Case of Chicago’s PrEPLine. AIDS Educ Prev . 2019;31(6):491-504. doi:10.1521/aeap.2019.31.6.491 Shah HS, Serrano PA, Phillips II G. The Adaptation and Reach of a PrEP Social Marketing Campaign for Latino/a/x Populations: Formative Research. JMIR Preprints . Accessed September 21, 2023. https://preprints.jmir.org/preprint/52842 PrEPárate. Available at: https://www.preparate.info. Accessed 16 Nov 2023. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health . 1999;89(9):1322-1327. doi:10.2105/AJPH.89.9.1322 Proctor E, Silmere H, Raghavan R, et al. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda. Adm Policy Ment Health . 2011;38(2):65-76. doi:10.1007/s10488-010-0319-7 Parsons JT, Rendina HJ, Lassiter JM, Whitfield THF, Starks TJ, Grov C. Uptake of HIV Pre-Exposure Prophylaxis (PrEP) in a National Cohort of Gay and Bisexual Men in the United States. J Acquir Immune Defic Syndr . 2017;74(3):285-292. doi:10.1097/QAI.0000000000001251 Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot . 1997;12(1):38-48. doi:10.4278/0890-1171-12.1.38 StataCorp. 2023. Stata Statistical Software: Release 18. College Station, TX: StataCorp LLC. Johnson GA, Vindrola-Padros C. Rapid qualitative research methods during complex health emergencies: A systematic review of the literature. Soc Sci Med . 2017;189:63-75. doi:10.1016/j.socscimed.2017.07.029 Kelly JA, Amirkhanian YA, Walsh JL, et al. Social network intervention to increase pre-exposure prophylaxis (PrEP) awareness, interest, and use among African American men who have sex with men. AIDS Care . 2020;32(sup2):40-46. doi:10.1080/09540121.2020.1739207 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3682611","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":254502409,"identity":"eb050cdf-d371-4601-a3a5-6af8d438bb22","order_by":0,"name":"Harita S. Shah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYBACAyA+wMBgw8AgwdgAFUsgQssBhjQStQCtOQzUAhcjoMWc/ezDwx9qzif2z25u/PDjlw0DP3uOAV4tlj3pBgcOHLudOOPOwWbJ3r40BsmeN/i1GBxIA/qF7XbiBonENgbensMMBjcI2GJw/hlQy79zYC2Mf4Fa7AlquQG05WDbAbAWZp4fQFskCGoB2nK2L9l4xo3EZmnZhjQeiTPPCgg4LI35Q8U3O9n+GekPP775YyPH3568Aa8WVMDYxsBDgnIw+EOqhlEwCkbBKBgJAAAy4lHnAePLLQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-8892-7753","institution":"University of Chicago","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Harita","middleName":"S.","lastName":"Shah","suffix":""},{"id":254502410,"identity":"fe5e95c5-0072-46b9-8196-93739421ffa2","order_by":1,"name":"Pedro A. 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In 2021, Latina/o/x individuals represented approximately 18% of the U.S. population but accounted for 29% of the 32,100 new HIV diagnoses, primarily in individuals characterized as SMM [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Latina TW also had a significantly higher HIV incidence relative to White TW [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The HIV incidence rate for Hispanic/Latino persons in 2021 was 4 times the rate for White persons [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Following national trends, Latina/o/x SMM and TW in Chicago, IL face disproportionately higher HIV incidence rates than their non-Hispanic White peers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Cook County, IL (including Chicago) is one of seven jurisdictions identified as driving the HIV epidemic among Latina/o/x populations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePre-exposure prophylaxis (PrEP) is a safe and effective means of biomedical HIV prevention [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Although use of PrEP has increased overall, uptake among minority communities has lagged behind [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The Centers for Disease Control and Prevention (CDC) reported in 2019 that the highest percentage of PrEP coverage was for White persons (63.3%), followed by Hispanic or Latino persons (14%), and Black or African American persons (8.2%) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Recent research concerning racial/ethnic and sexual identity differences in PrEP uptake in Chicago indicated PrEP-eligible Latina/o/x men were less likely to receive a PrEP prescription than their White peers [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThrough the lens of intersectionality, Latina/o/x SMM and TW experience intersecting forms of social marginalization (e.g. racism, heterosexism, cisgenderism) that create multilevel barriers to care engagement [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Barriers to PrEP uptake among Latina/o/x SMM and TW include structural (e.g., lack of insurance, structural racism), community (e.g., PrEP prejudice, sexual stereotypes) and individual factors (e.g., mistrust, fear of side effects) [\u003cspan additionalcitationids=\"CR13 CR14 CR15\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Structural barriers to PrEP use by Latina/o/x populations often include lack of health insurance, language discordance, limited health literacy, and immigration status [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. At the community level, Latina/o/x SMM and TW are often dissuaded by peers or romantic partners from taking PrEP to avoid the stigma of being labeled as sexually irresponsible, promiscuous, or immoral [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. On an individual level, common barriers to PrEP uptake among Latina/o/x SMM and TW include medical mistrust, wariness of side effects, and lack of awareness [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Prior studies have shown significantly lower rates of awareness among Latina/o/x individuals with limited English proficiency (LEP) in comparison to their non-Latina/o/x peers [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn studies of PrEP interest and acceptability, while awareness was initially low, once aware of PrEP, Latina/o/x SMM reported willingness to adopt PrEP at the same or higher levels than non-Latina/o/x SMM [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Given the disproportionate burden of the HIV epidemic and lack of PrEP awareness among Latina/o/x SMM and TW, there is an urgent need to identify effective, tailored interventions to increase PrEP awareness and uptake in these populations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Moreover, it is critical that PrEP interventions for Latina/o/x SMM and TW utilize community-based participatory research (CBPR) approaches to understand and synchronously address multilevel, intersectional barriers to PrEP uptake and retention [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. CBPR is a collaborative approach that equitably involves community partners throughout the research process, facilitating empowerment of marginalized populations as well as optimizing translation and sustainability of HIV interventions [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSocial marketing interventions are an effective means of improving HIV testing among Latina/o/x SMM and TW and thus offer tremendous potential as a tool to promote PrEP [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Social marketing involves the application of commercial marketing principles to design and implement programs to affect health behavior change, often through social media and offline advertisements [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. PrEP social marketing campaigns have raised awareness and uptake of PrEP in other populations, but few have been tailored to Latina/o/x SMM and TW. Among Black SMM and TW in Chicago, exposure to the PrEP4Love social marketing campaign was associated with increased PrEP awareness and 87% higher utilization of PrEP [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In other settings, some PrEP campaigns have been developed for Black and Latina/o/x SMM jointly; however, these groups have distinct cultural differences and they may be better served by separately tailored interventions [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR29 CR30 CR31\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Latina TW are notably underrepresented in PrEP intervention research [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Of the limited PrEP social marketing interventions that include Latina/o/x SMM or TW, few evaluated clinical outcomes such as PrEP uptake [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe created the PrEP\u0026aacute;rate social marketing intervention through partnerships between the Chicago Queer Latinx (CQL) Collaborative and investigators at the University of Chicago, Northwestern University, and Cook County Health. The CQL Collaborative is a group of 10 Latina/o/x and LGBTQ\u0026thinsp;+\u0026thinsp;stakeholders representing community-based organizations (CBOs) that provide HIV services to Latina/o/x individuals. Following the principles of CBPR, these community stakeholders were partners in all stages of the project\u0026rsquo;s development, implementation, and evaluation [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. We adapted the PrEP4Love campaign for a Latina/o/x audience through focus groups, surveys, and crowdsourcing over social media [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Local Latina/o/x artists created the content, which featured recognizable Chicago-based Latina/o/x campaign ambassadors (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Paid advertisements were distributed on Facebook, Instagram, YouTube, Grindr, and social media pages of Latina/o/x health focused community-based organizations. Physical content included posters, flyers, Chicago Transit Authority bus and train advertisements (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), and giveaway items at community events. Advertisements directed people to the PrEP\u0026aacute;rate website which featured PrEP information in English and Spanish, and options to access PrEP online or through the HIV Resource HUB bilingual hotline [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The PrEP\u0026aacute;rate social marketing intervention ran from April 2022 to September 2022.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eWe evaluated the PrEP\u0026aacute;rate social marketing intervention using a mixed methods approach, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Social media metrics of reach are published elsewhere [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In its first year, PrEP\u0026aacute;rate reached over 118,750 people on social media with additional reach at community events and over Chicago public transit advertisements.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurveys\u003c/h2\u003e \u003cp\u003e We conducted cross-sectional surveys between November 2022 and June 2023 to evaluate campaign reach and effectiveness. Eligible participants self-identified as Hispanic or Latina/o/x, 18 years of age or older, and living in Cook County, IL. Online recruitment entailed distribution of a Qualtrics link over Chicago Latina/o/x-centric social media groups, followed by an option to share with peers upon survey completion. In-person recruitment occurred at community events, Latina/o/x-focused health centers, bars, and consulates. Surveys were available in English and Spanish and assessed socio-demographics, exposure to the PrEP\u0026aacute;rate campaign, if and how the PrEP\u0026aacute;rate campaign impacted them, and primary outcomes of PrEP awareness and PrEP uptake. Survey respondents were offered a \u003cspan\u003e$\u003c/span\u003e15 gift card for their participation.This project was deemed exempt by the University of Chicago Institutional Review Board because it involved surveys and interviews with no more than minimal risk to participants.\u003c/p\u003e \u003c/div\u003e\n\u003ch2\u003ePrEP Awareness\u003c/h2\u003e\n\u003cp\u003eWe assessed exposure to PrEP\u0026aacute;rate by asking if respondents had seen or heard of the PrEP\u0026aacute;rate campaign, with a color logo to minimize confusion with other campaigns. PrEP awareness was measured by asking, \u0026ldquo;What is your experience with PrEP (pre-exposure prophylaxis) as of today?\u0026rdquo; with options of \u0026ldquo;I have never heard of PrEP,\u0026rdquo; \u0026ldquo;I have heard of PrEP but have not taken it,\u0026rdquo; \u0026ldquo;I have been on PrEP before but not currently,\u0026rdquo; or \u0026ldquo;I am currently on PrEP.\u0026rdquo; Responses of \u0026ldquo;I have never heard of PrEP\u0026rdquo; were categorized as \u0026ldquo;Not Aware\u0026rdquo; of PrEP, and any of the other responses to this question were categorized as \u0026ldquo;Aware\u0026rdquo; of PrEP.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePrEP Uptake\u003c/h2\u003e \u003cp\u003eSurveys also included the Motivational PrEP Cascade to assess for potential impact at different stages of behavior change [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The Motivational PrEP Cascade is based on the Transtheoretical Model of Change to assess behavior change in the context of PrEP decision making over time, with the fourth stage being PrEP uptake [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. We included survey questions that assessed for four stages of the Motivational PrEP Cascade: (1) PrEP Precontemplation, individuals who are unwilling to take PrEP or do not believe they are appropriate candidates; (2) PrEP Contemplation, individuals who are willing to initiate PrEP and self-identify as an appropriate candidate; (3) PrEParation, individuals who are planning to initiate PrEP; (4) PrEP Action \u0026amp; Initiation, individuals who have spoken with a provider and initiated PrEP.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eQualitative Interviews\u003c/h2\u003e \u003cp\u003eWe conducted 14 total semi-structured interviews. We interviewed Latina/o/x SMM and TW community members to assess campaign effectiveness, appropriateness and acceptability until reaching thematic saturation [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Interviewees were selected using a random number generator to select from survey respondents who marked their interest. Interview topics included PrEP awareness, PrEP\u0026aacute;rate exposure, appropriateness and acceptability, and future directions for similar work.\u003c/p\u003e \u003cp\u003eAdoption, implementation, and maintenance were evaluated through semi-structured interviews with CQL Collaborative members. All collaborative members were invited to participate.\u003c/p\u003e \u003cp\u003eAll interviews were conducted over Zoom with audio recordings and transcribed using Otter.ai. Transcripts were cleaned by a trained bilingual research assistant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis:\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eSurveys\u003c/h2\u003e \u003cp\u003eWe compared socio-demographics between respondents with and without PrEP\u0026aacute;rate exposure using chi-squared analyses. We examined associations between PrEP\u0026aacute;rate exposure and the primary outcomes of PrEP awareness and PrEP uptake (stage 4 of the Motivational PrEP Cascade) using binary and ordinal logistic regression, respectively. People were identified as SMM if they self-reported male gender and sexual orientation as gay, bisexual, or queer.\u003c/p\u003e \u003cp\u003eVariables included in the multivariable models were identified through univariate analyses and were consistent with prior literature. Covariates in the PrEP awareness analysis included age, education level, English proficiency, primary care access, and sexual orientation. Covariates in the PrEP uptake analysis included age, education level, English proficiency, sexual orientation, and number of sexual partners in the last three months. Insurance status, race, health literacy, survey language, and transgender status were other variables considered for both models, but they were ultimately not selected and not significant on univariable analysis. All analyses were conducted in STATA version 18 [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eQualitative Interviews\u003c/h2\u003e \u003cp\u003eQualitative interview data were analyzed using rapid qualitative methods, which has been shown to be an effective strategy for timely results in implementation science [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Each transcript was independently reviewed by 2 team members trained in rapid qualitative methods. Key points and quotes were included in a templated summary document. The templated summary documents were then moved to a matrix to identify key themes. Discrepancies were resolved through weekly meetings where expert qualitative analysts discussed data deviances and result issues to achieve consensus.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative Results\u003c/h2\u003e \u003cp\u003e515 survey responses were collected between November 1, 2022, and June 30, 2023. Participant demographics and the primary outcomes of PrEP awareness and PrEP uptake are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Most survey respondents were age 18\u0026ndash;34 years (n\u0026thinsp;=\u0026thinsp;374, 72.6%) and completed the survey in English (n\u0026thinsp;=\u0026thinsp;356, 69.1%) versus Spanish (n\u0026thinsp;=\u0026thinsp;159, 30.9%). 30.7% (n\u0026thinsp;=\u0026thinsp;158) identified as sexual minority men (SMM). 3.1% (n\u0026thinsp;=\u0026thinsp;16) identified as transgender women and 6.8% (n\u0026thinsp;=\u0026thinsp;35) identified as non-binary. In terms of PrEP\u0026aacute;rate exposure, 31.5% (n\u0026thinsp;=\u0026thinsp;162) reported having seen or heard of the PrEP\u0026aacute;rate social marketing intervention.\u003c/p\u003e \u003cp\u003e When asked if and how the PrEP\u0026aacute;rate intervention affected those exposed, 42.0% (n\u0026thinsp;=\u0026thinsp;66) said they learned about PrEP and HIV prevention, 34.4% (n\u0026thinsp;=\u0026thinsp;54) said it provided information on how to access PrEP, 15.3% (n\u0026thinsp;=\u0026thinsp;24) said it influenced them to start PrEP, and 3.8% (n\u0026thinsp;=\u0026thinsp;6) found a PrEP provider. 82.8% (n\u0026thinsp;=\u0026thinsp;130) said it impacted them in at least one way, with only 17.2% (n\u0026thinsp;=\u0026thinsp;27) reporting no impact.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurvey Respondent Demographics by PrEP\u0026aacute;rate Campaign Exposure\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal N\u0026thinsp;=\u0026thinsp;515\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo PrEP\u0026aacute;rate Exposure (N, %)\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;353\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrEP\u0026aacute;rate Exposure (N, %)\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;162\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Categories\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.250\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42 (25.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e165 (46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86 (53.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNative American or Alaskan Native\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack or African American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNative Hawaiian or Pacific Islander\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100 (28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50 (30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e122 (34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDid not answer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92 (26.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender and Transgender Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCisgender Men\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e174 (55.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73 (51.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCisgender Women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e111 (35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38 (26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNonbinary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender Men\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender Women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexual Orientation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeterosexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e136 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBisexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85 (24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesbian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQueer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexual Minority Men (SMM)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96 (27.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.640\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompleted high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e189 (53.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92 (56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80 (22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (21.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvanced degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHIV Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e236 (67.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125 (78.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever been tested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94 (26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth Literacy Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e258 (73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138 (85.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnglish Proficiency Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnglish Proficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e219 (62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125 (77.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSomewhat English Proficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimited English Proficiency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Insurance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94 (29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicaid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e132 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78 (50.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrEP Awareness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Aware\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e155 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e169 (52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134 (87.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrEP Motivational Cascade Stage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 (PrEP Pre-Contemplation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95 (34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 (PrEP Contemplation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 (PrEParation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 (PrEP Action and Initiation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrEP Experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever used PrEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e155 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreviously on PrEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e140 (43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102 (66.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrently on PrEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePrEP awareness\u003c/h2\u003e \u003cp\u003ePeople who were exposed to PrEP\u0026aacute;rate had a higher odds of PrEP awareness relative to people who were not exposed to PrEP\u0026aacute;rate (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), adjusting for age, education, LEP, primary care access, and sexual orientation. People who saw PrEP\u0026aacute;rate were about five times more likely than people who did not see PrEP\u0026aacute;rate to be aware of PrEP.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between PrEP\u0026aacute;rate Exposure and PrEP Awareness in Various Models\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal N\u0026thinsp;=\u0026thinsp;515\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUnadjusted Model N\u0026thinsp;=\u0026thinsp;478\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted Model\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;363\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAware of PrEP (N, row %)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eUnaware of PrEP\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(N, row %)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR of PrEP Awareness (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaOR of PrEP Awareness (95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExposed to PrEP\u0026aacute;rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134 (87.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.14**\u003c/p\u003e \u003cp\u003e(3.66, 10.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.23**\u003c/p\u003e \u003cp\u003e(2.58, 10.63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNot Exposed to PrEP\u0026aacute;rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e169 (52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003eAdjusted Model: Adjusted for age, education, limited English proficiency, primary care access, and sexual orientation.\u003c/p\u003e \u003cp\u003e**Statistically significant p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePrEP Uptake\u003c/h2\u003e \u003cp\u003eThe association of PrEP\u0026aacute;rate campaign exposure with PrEP uptake was measured through ordered logistic regression given the PrEP Motivation Cascade consists of four unique ordered stages, with PrEP uptake being the final stage [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The odd ratios obtained from ordered logistic regression express the odds of participants being in stage 4 (PrEP uptake) relative to stages 1 through 3. People exposed to the PrEP\u0026aacute;rate campaign had a higher odds of PrEP uptake relative to people not exposed to PrEP\u0026aacute;rate (aOR: 1.69 95% CI: 1.09, 2.62), adjusting for age, education, limited English proficiency, sexual orientation, and number of sexual partners in the last three months (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation Between PrEP\u0026aacute;rate Exposure and PrEP Uptake\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal N\u0026thinsp;=\u0026thinsp;515\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUnadjusted Model N\u0026thinsp;=\u0026thinsp;403\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted Model\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;373\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStages 1\u0026ndash;3\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(N, row %)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eStage 4: PrEP Uptake\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(N, row %)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR of PrEP Uptake (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaOR of PrEP Uptake (95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExposed to PrEP\u0026aacute;rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.58**\u003c/p\u003e \u003cp\u003e(1.74, 3.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.69*\u003c/p\u003e \u003cp\u003e(1.09, 2.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNot Exposed to PrEP\u0026aacute;rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e250 (90.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003eAdjusted model: Adjusted for age, education, limited English proficiency, sexual orientation, and number of sexual partners in the last three months.\u003c/p\u003e \u003cp\u003e*Statistically significant p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003cp\u003e**Statistically significant p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eQualitative Results\u003c/h2\u003e \u003cp\u003eA total of 14 interviews were completed to assess implementation outcomes following the RE-AIM framework. We conducted interviews with seven SMM and TW community members to assess intervention effectiveness. Community members had a median age of 27 years, were English proficient, had completed high school, and identified as SMM (n\u0026thinsp;=\u0026thinsp;5), as a transgender woman (n\u0026thinsp;=\u0026thinsp;1) or as transgender non-binary (n\u0026thinsp;=\u0026thinsp;1). Seven CQL Collaborative members participated in interviews assessing the adoption, implementation, and maintenance of the intervention.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eEffectiveness\u003c/h2\u003e \u003cp\u003eSMM and TW community members interviewed found PrEP\u0026aacute;rate to be acceptable and appropriate. Community members felt the campaign was appropriate for queer and bilingual Latina/o/x audiences because of the playful colors, incorporation of Spanish language, and diverse representation of ambassadors in campaign materials. Community members liked the PrEP\u0026aacute;rate logo and design because it felt representative of Latina/o/x communities. They recalled seeing PrEP\u0026aacute;rate on CTA advertisements, social media, YouTube, and Grindr ads. Some participants wished for greater representation of Black Latina/o/x individuals, older individuals, and people assigned female at birth.\u003c/p\u003e \u003cp\u003eCommunity members overall felt the campaign was impactful. They discussed that PrEP\u0026aacute;rate impacted them in different ways: considering if PrEP was right for them, serving as a tool they recommended to others, and affecting the younger generation\u0026rsquo;s awareness and access to PrEP.\u003c/p\u003e \u003cp\u003e\"By giving it that bright color, the pop of life, the celebratory feel, we're reframing people's perspectives\u0026hellip;this doesn't have to be a bad thing, protection and health and advocating for myself doesn't have to be something that has to be traumatic.\u0026rdquo; -Community Member Interview\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eAdoption\u003c/h2\u003e \u003cp\u003eCQL Collaborative partners noted that Latina/o/x-based community organizations adopted materials, especially if the CBO was represented by a person in the CQL Collaborative. A barrier to adoption of the campaign was delays in distribution of grant funding. Once CBOs adopted the campaign materials, they found materials to be effective conversation starters at tabling events or with CBO clients. Social media was also an important facilitator for adoption by community groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eImplementation\u003c/h2\u003e \u003cp\u003eWhen developing PrEP\u0026aacute;rate, CQL Collaborative partners felt heard and thought the community artists accurately captured the project vision. Barriers to campaign development included funding and administrative delays. Once PrEP\u0026aacute;rate launched, the name of the campaign and the featuring of identifiable local ambassadors were effective in engaging members of the public. CQL Collaborative partners believed that the combination of advertising on the CTA and social media was effective, and suggested more in-person outreach in the future to more effectively reach marginalized populations. They noted that all of the ambassadors were young adults and would have liked to see diversity in age, including older adults, be highlighted in the campaign. Despite this, the campaign was well received at community events by different generations.\u003c/p\u003e \u003cp\u003e\u0026ldquo;We did the thing that we set out to do, right, of like creating a social media campaign that was about engaging Latinos in this conversation around PrEP.\u0026rdquo; \u0026ndash; CQL Collaborative Member Interview\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eMaintenance\u003c/h2\u003e \u003cp\u003eTo maintain PrEP\u0026aacute;rate, CQL Collaborative partners expressed the need for ongoing funding to continue and expand marketing efforts. Potential barriers identified included the political climate, social media limits on targeting and advertising, and uncertainty that the intervention could reach highly marginalized populations. CQL Collaborative partners were excited about opportunities to build on or expand the campaign. Future iterations of the campaign could include local Latina/o/x community centers such as libraries, shops, and churches to expand reach beyond SMM and TW. They discussed tailoring the campaign to certain groups such as older Spanish-speaking immigrants and addressing social determinants of health that affect PrEP uptake such as mental health, substance use, or employment. CQL Collaborative partners also expressed interest in adapting and expanding PrEP\u0026aacute;rate for other populations across the United States.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrEP\u0026aacute;rate is one of the first PrEP social marketing interventions tailored specifically to Latina/o/x SMM and TW. Exposure to PrEP\u0026aacute;rate was significantly associated with increased PrEP awareness and PrEP use, suggesting that culturally-responsive social marketing interventions may be an effective means of addressing PrEP disparities. The qualitative evaluation showed that PrEP\u0026aacute;rate was developed and implemented with fidelity and was well received by the target audience. By combining social marketing with community engagement, PrEP\u0026aacute;rate achieved a wide reach while simultaneously addressing common barriers to care.\u003c/p\u003e \u003cp\u003eAmong the few PrEP social marketing interventions tailored to Latina/o/x populations, even fewer have assessed clinically relevant outcomes such as PrEP awareness and uptake. Our results support findings from social marketing studies in Black populations and diverse populations which found increases in PrEP awareness and uptake [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. PrEP\u0026aacute;rate was adapted from PrEP4Love, a PrEP-focused social marketing campaign in Chicago tailored to Black populations, in which individuals who had seen PrEP4Love ads were more likely to have taken PrEP in the last six months [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Similarly, our findings showed higher odds of PrEP uptake in Latina/o/x individuals who had seen PrEP\u0026aacute;rate. We believe that providing multiple options for PrEP access, beyond promoting awareness alone, was essential to facilitating PrEP uptake.\u003c/p\u003e \u003cp\u003eCommunity engagement with local Latina/o/x community members and CBOs was essential to producing an intervention that resonated with local Latina/o/x individuals. Several prior PrEP social marketing interventions have been broadly marketed to people of color, or jointly to Black and Latina/o/x gender and sexual minority individuals [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Multiply-marginalized populations such as Black and Latina/o/x LGBTQ\u0026thinsp;+\u0026thinsp;individuals have unique histories and intersectional identities that can often be better served by culturally responsive, tailored interventions [\u003cspan additionalcitationids=\"CR29 CR30 CR31\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. We found that using a range of community engagement strategies including focus groups, interviews, a crowdsourcing contest, contracting local artists and designers to create the campaign, shared ownership with the CQL Collaborative, and feedback from local Latina/o/x youth and adult advisors allowed for greater community input and empowerment [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The results of this work - the PrEP\u0026aacute;rate campaign name, vibrant colors, and relatable ambassadors - were found to be key to engaging members of the Latina/o/x community. Featuring local campaign ambassadors encouraged Latina/o/x SMM and TW to consider PrEP by highlighting the positive experiences of trusted community members.\u003c/p\u003e \u003cp\u003eOur study had multiple limitations. One inherent limitation of this pilot project was the cross-sectional nature of the evaluation. It is possible that some of the effect could be explained by the intervention preferentially reaching younger SMM and TW with higher education and greater baseline exposure to PrEP. Future research should explore these findings through rigorous longitudinal or randomized design. A second limitation was the time between the intervention and the evaluation. Due to administrative and funding delays, surveys and interviews were conducted up to 9 months after the end of the campaign. This delay may have reduced campaign recall, though it is encouraging that for some people exposed, the campaign was memorable even months later. Finally, a nonrandom sample of survey participants was used, as we partnered with local organizations to recruit an adequate sample of SMM and TW. Participants recruited through HIV-focused CBOs may have been more experienced with HIV prevention. The SMM and TW interviewees were also survey participants who consented to an interview and may have been subject to selection bias. Thus, this evaluation may not have reached individuals who are not well connected to Latina/o/x community-based organizations, community events, or social media. Future interventions and evaluation should include dedicated outreach to highly marginalized Latina/o/x populations.\u003c/p\u003e \u003cp\u003eUltimately, community-driven PrEP social marketing campaigns tailored to Latina/o/x populations may be a promising means of increasing PrEP awareness and uptake among Latina/o/x populations. Promoting awareness while simultaneously addressing barriers to PrEP access is key to reducing disparities along the PrEP care continuum. The impact of PrEP\u0026aacute;rate was only possible through strong community partnerships in the development, implementation, and evaluation of the campaign. Future directions for research based on our qualitative evaluation include addressing PrEP stigma, dedicated outreach to individuals with LEP, and multi-level interventions to address mental health needs and social determinants of health that impact HIV vulnerability within Latina/o/x communities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCenters for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data\u0026mdash;United States and 6 dependent areas, 2019. HIV Surveillance Supplemental Report 2021;26(No.2). http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published May 2021. Accessed 16 Nov 2023.\u003c/li\u003e\n\u003cli\u003eCenters for Disease Control and Prevention. 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Social network intervention to increase pre-exposure prophylaxis (PrEP) awareness, interest, and use among African American men who have sex with men. \u003cem\u003eAIDS Care\u003c/em\u003e. 2020;32(sup2):40-46. doi:10.1080/09540121.2020.1739207\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Chicago Medical Center","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"PrEP, Latino, social marketing, HIV prevention, community","lastPublishedDoi":"10.21203/rs.3.rs-3682611/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3682611/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Latina/o/x sexual minority men (SMM) and transgender women (TW) remain disproportionately impacted by HIV, with higher HIV incidence and lower uptake of pre-exposure prophylaxis (PrEP) than non-Hispanic white peers. Disparities in PrEP uptake among Latina/o/x populations have been found to be due to structural, social, and personal barriers. Social marketing interventions have been shown to effectively address barriers and increase PrEP uptake in other populations, and thus offer potential as a tool to increase PrEP uptake for Latina/o/x populations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: The PrEPárate campaign was developed through community based participatory research and ran from April to September 2022 in Cook County, Illinois. We conducted a mixed methods evaluation through surveys (N=515) and semi-structured interviews with community partners and survey participants (N=14). Cross-sectional associations of campaign exposure with PrEP awareness and uptake were examined in covariate-adjusted multivariable regression models. We used rapid qualitative methods to analyze interviews and assess implementation outcomes using the RE-AIM framework.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The campaign reached over 118,000 people on social media, with additional reach over public transit. PrEPárate exposure was associated with increased PrEP awareness (aOR= 5.23; 95% CI = (2.58, 10.63) and PrEP uptake (aOR= 1.69; 95% CI = (1.09, 2.62). Qualitative analysis found the campaign to be acceptable, appropriate, and implemented with fidelity. Future directions for PrEPárate include expanding adoption and focusing on PrEP stigma reduction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Social marketing campaigns can be an effective strategy to increase PrEP awareness and uptake among underserved Latina/o/x populations. Community engagement is essential to the development of tailored, acceptable, and appropriate interventions.\u003c/p\u003e","manuscriptTitle":"PrEPárate: Evaluation of a Community-Driven PrEP Social Marketing Intervention Tailored to Latina/o/x Individuals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-11-30 18:14:10","doi":"10.21203/rs.3.rs-3682611/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d43623bb-980f-44a1-ba78-f9a92e967d03","owner":[],"postedDate":"November 30th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-11-30T18:14:10+00:00","versionOfRecord":[],"versionCreatedAt":"2023-11-30 18:14:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3682611","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3682611","identity":"rs-3682611","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}