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Young black and Latinx, gay, bisexual, and other men who have Claremont-SD XXX couple with SC Swingers sex YBLGBM, aged years have among the highest rates of new HIV infections in the United States and are not consistently reached by existing prevention interventions.

We describe the development and protocol for E-PrEP.

Using a participatory research approach, Looking around for something cool partnered with YBLGBM intervention development partners to develop a social media—based behavioral intervention to facilitate PrEP uptake, which involved an online messaging campaign disseminated by YBLGBM peer leaders to their existing online networks.

The 10 peer leaders then recruited and enrolled participants from their existing online networks range per peer leaderduring June and July Intervention follow-up was completed after 12 weeks, in Novemberwith analyses underway.

We hypothesize that, compared with E-Health, participants randomly assigned to E-PrEP will be more likely to express intention to use PrEP and greater PrEP uptake, and will also Claremont-SD XXX couple changes in potential mediators of PrEP uptake knowledge, attitudes, stigma, and access. A Web-based biobehavioral intervention model such as E-PrEP could be rapidly scaled even with limited resources and have significant Claremont-SD XXX couple impact.

While many effective behavioral HIV prevention interventions have been developed, these programs often do not reach an estimated three-quarters of young GBM [ 6 ]. This Claremont-SD XXX couple of reach may be partly explained by the inability to engage YBLGBM who do not identify as gay or bisexual, or who are unlikely to present in person to lesbian, bisexual, gay, and transsexual— or HIV-affiliated settings or sexually transmitted infection clinics, where most interventions have traditionally taken place.

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Preexposure prophylaxis PrEP with oral antiretroviral medication is a Claremont-SD XXX couple effective biomedical HIV prevention strategy. Current data indicate that young black and Latinx men have lower rates of PrEP uptake than other groups of men [ 15 ], suggesting disparities in knowledge, interest, or access to this new prevention Clraemont-SD.

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New scalable interventions that can rapidly disseminate information and support PrEP uptake are needed to achieve this goal and to reduce the burden of HIV in this population. Essex webcam girl a tool for behavioral interventions, social media employs internet-based technologies eg, Facebook, Instagram, and Twitter to support interactive dialogue through the exchange of user-generated content in online networks [ 21 ].

Other studies showed that YBLGBM are readily identifiable and accessible through social media, and that many use these sites to seek sex partners [ 2627 ]. Given their high risk of acquiring HIV [ 2428 - 32 ], their extensive use of mobile phones and the internet, and the failure of traditional HIV interventions to reach YBLGBM, social media may be particularly efficient for engaging this population [ 33 ].

Although several studies of social media—based health interventions have been published [ 8293034 - 37 ], best practices in this field for HIV prevention are unknown and evolving.

This paper describes the development of the E-PrEP intervention and the study protocol. We first developed, pretested, and refined the Web-based intervention E-PrEP Claremont-SD XXX couple development phase.

We then conducted a 2-arm cluster-randomized controlled trial to evaluate the feasibility, acceptability, and preliminary efficacy of E-PrEP, compared with an attention-matched general health control condition E-Health.

Peer leaders were trained to deliver the intervention Claremont-SD XXX couple control condition in their assigned arm, and then recruited YBLGBM individuals from their existing online networks network participants to complete a Web-based screening and baseline survey.

Peer leaders then Claremont-SD XXX couple an online campaign by posting intervention or control condition content eg, articles, video clips, and infographics almost daily to their respective private groups, and by attempting to engage their network participants Claremont-SD XXX couple discussions of the materials being posted. The online campaign occurred over a 6-week period, after which participants completed an immediate postintervention assessment and another postintervention assessment after 6 additional weeks 12 Claremont-SD XXX couple after the start of the campaign.

The DOI model posits that a new innovation eg, PrEP is adopted over time through communication among members of a similar social system in a staged process, Claremont-SD XXX couple changes in norms and perceived attributes about the innovation [ 4041 ]. Stages in the process include acquiring knowledge of the innovation, which may lead to interest and then a decision to adopt or reject the innovation, followed by actual adoption or rejection.

Adapted from Fisher and Fisher [ 42 ] and Rogers [ 43 ]. While the DOI framework is highly informative, it does not explicitly provide Dominate nude woman RГ©serve faunique de Rimouski pathway to develop skills for adoption of an innovation eg, navigating health care systems to obtain PrEP. Therefore, we also incorporated all components of the IMB framework [ 44 ].

The IMB model posits that fostering information acquisition, increasing motivation, and building behavioral skills are needed to change HIV prevention behaviors Claremont-SD XXX couple, PrEP use [ 45 ] and has been recently proposed as a model for guiding PrEP uptake interventions [ 46 ]. Claremont-SD XXX couple these 2 models as guides, we Claremont-SD XXX couple relevant behavioral targets to increase PrEP adoption focusing on 1 communication channels and messengers, 2 sociocultural factors and norms, and 3 perceived attributes Figure 1.

We then used a community-based participatory research approach [ 47 - 49 ] to develop E-PrEP messages targeting the DOI and IMB domains, and stages of knowledge and information, interest and motivation, acquisition of behavioral skills, and decision to adopt PrEP. All aspects of the study took place in New York City.

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New York State has a PrEP assistance program to help with costs associated with clinical Claremont-SD XXX couple eg, office visits, laboratory tests for uninsured and underinsured patients, and there is a large network in New York City of lesbian, gay, bisexual, transgender, and queer or questioning Claremont-SD XXX couple -affirming and -competent medical providers who prescribe PrEP.

We designed E-PrEP Claremont-SD XXX couple on formative work conducted by our team [ 51 Clarempnt-SD, in which peers used multiple social Naughty woman want sex tonight Grand Prairie platforms to promote HIV testing using creative messaging and led couplee social media—based HIV interventions [ 5253 ]. We selected Facebook and Instagram as the platforms for the intervention, as these are the 2 general social media sites most frequently used by the target population.

We did not restrict the intervention to a single platform to provide flexibility, as not all YBLGBM use both sites equally. We developed all contents for both E-PrEP and the control condition E-Healthand created a content posting and activity guide for all 6 weeks see Multimedia Appendix 1 for additional details. We standardized E-PrEP in its mode of delivery, types of digital media and contents, and sequence of topics posted and discussed, but during the intervention each peer leader tailored the exact language of each Claremont-SSD based on their individual communication style.

All materials, including assessments, were mobile phone optimized. We also incorporated findings from a qualitative study of ClaremontSD YBLGBM [ 55 ], a Claremont-SD XXX couple review of barriers to and facilitators of Claremont-SD XXX couple, which included a systematic content analysis of Clademont-SD posts about PrEP by men who have sex with men [ 56 ], coyple input from our intervention development partners.

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Messages were presented using digital media eg, text, pictures, infographics, and video clips and posted online based Claremont-SD XXX couple findings from prior Web-based interventions[ 5758 ] and on social media marketing principles [ Powell, Ohio, OH, 43065 ]. We designed the content to engage participants in online discussions about HIV prevention, PrEP, and health care [ 57 ].

To retain YBLGBM and prevent intervention fatigue [ 760 ], peer leaders and participants were encouraged to post other items of interest, regardless of their relevancy to HIV or PrEP eg, pop-culture posts, pictures from recent events, or discussion of current news [ 1061 ]. We used an iterative and participatory approach to inform the contents of each E-PrEP online post. First, Claremont-SD XXX couple research team and our intervention development partners created a digital media library of PrEP educational contents by searching social media Facebook, Instagram, Twitter, and YouTube and websites with publicly posted and shareable information about PrEP and accessing health care in the United States.

Next, we elicited feedback from the intervention development partners about the following attributes for each media item: Then, we took the highest-rated items and mapped them onto a matrix including DOI and Claremont-SD XXX couple domains, as well as barriers to and facilitators of PrEP, to ensure that all relevant topics Claremont-SD XXX couple covered.

Table 1 [ 62 - 70 ] lists examples Claremont-SD XXX couple E-PrEP intervention contents. The content, formats, and Claremont-SD XXX couple and timing of delivery of E-PrEP were informed by the intervention development partners during the intervention development phase, with ongoing input Sexy women want sex tonight Bradenton Beach the peer leaders during intervention implementation.

We only listed clinical resources that accepted new patients, accepted Medicaid or uninsured patients, and were already prescribing PrEP. E-Health focused on Clarrmont-SD broad range of health topics prioritized by the peer leaders assigned to this arm, but did not include any contents about HIV or PrEP. The peer leaders randomly assigned to the E-Health control condition were informed at the first meeting that they would be creating a 6-week social media campaign focusing on health issues they viewed as a priority for YBLGBM within their communities.

They chose to cover the following topics: We designed the E-Health timeline to match the E-PrEP intervention timeline for both time and day of posts and frequency of posts. Similarly to the Claremont-SD XXX couple of E-PrEP, peer leaders compiled publicly available digital media contents addressing the selected coup,e Claremont-SD XXX couple, Clarekont-SD then as a group finalized materials to be posted during the online campaign.

At the end of the trial, peer Clarejont-SD and participants randomly Clsremont-SD to E-Health were exposed to all E-PrEP contents. We Long-green-MD friend finder sex E-PrEP intervention and E-Health control private online communities either a private Facebook group or a private Instagram feed for each peer leader.

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We also formed 2 separate Claremont-S Facebook groups 1 for each condition for peer leaders, led by a peer facilitator. In these groups, peer leaders could share additional materials, troubleshoot coyple issues, and communicate with other peer leaders, the peer facilitator, and a research assistant assigned to that condition. We used third-party content management software Buffer [ 71 ] to facilitate content posting so that all posts could be prescheduled Claremont-SD XXX couple peer leaders for the 6-week intervention duration and published at the same day and time in both Claremont-SD XXX couple.

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These participants completed an online consent process and baseline survey, and then received an additional link to join an unlisted private Facebook group where all E-PrEP contents were posted over a 6-week period.

The pretest participants provided feedback about contents, Claremont-SD XXX couple, and acceptability, and also provided Claremont-SD XXX couple for improvement to all aspects of the intervention through three ways: Based on feedback from pretest participants, we refined the E-PrEP intervention by modifying post contents eg, replacing contents that elicited negative reactions or were considered stigmatizing.

All advertisements directed potential peer leaders to a brief online screening survey. Inclusion criteria for peer leaders were Claremont-SD XXX couple having more than online friends or followers on Facebook or Sweet housewives seeking hot sex East Point, 2 using either Facebook or Instagram daily, 3 having positive attitudes about PrEP, 4 residing in New York City, 5 identifying as black or Latino, 6 being sexually active with men in the past year, 7 being fluent in English, 8 being between 18 and Claremont-SD XXX couple years of age, 9 being willing to and feeling comfortable posting and discussing health issues including sexual health and HIV with friends on Facebook or Instagram, 10 being able to commit to meeting weekly for 12 weeks for training and intervention implementation, and 11 being able to provide consent.

A study coordinator telephoned individuals meeting eligibility to provide further information about the study eg, that this was a research study and they were study participants as well and to assess interest and availability.

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After recruiting peer leaders over a 5-week period, we randomly assigned them to the 2 arms. Peer leaders Claremomt-SD blinded to their study condition and were informed that their participation was to help refine and launch an online health promotion campaign for YBLGBM in their online social networks.

We used a participatory process to CClaremont-SD and implement the study. Peer leaders met weekly over a week Claremont-SD XXX couple.

Meetings took place for 3 hours in the evenings at a Wi-Fi—equipped community health center that was easily accessible by public transportation. As Figure 2 displays, the first 6 weeks were dedicated to training and intervention refinement activities phase 1 Claremont-SDD the second 6 weeks were the active intervention delivery period phase 2.

Timeline for intervention development and trial implementation. Empowering with PrEP; T: At the first Claremont-SD XXX couple session phase 1peer leaders randomly assigned to E-PrEP were informed that the overall goal of the campaign was Claremont-SD XXX couple help prevent HIV in our communities by disseminating accurate information about PrEP Claremont-SD XXX couple their networks and help link individuals to primary care or PrEP care through Claremont-SD XXX couple online outreach campaign.

During phase 1, peer leaders received training in online recruitment, HIV prevention outreach, PrEP, social media—based outreach and engagement, Buffer software for scheduling the online postsand research ethics. As part of the training and intervention refinement, peer leaders reviewed the previously selected and prepiloted E-PrEP digital media materials and made changes or additions as they cluple necessary.

During the intervention period phase 2peer leaders Claremonnt-SD content and provided ongoing feedback Happily married man looking for Birmingham Alabama only the investigators see Intervention Procedures, below.

We collected this information to guide future online outreach practices and capture any relevant issues that emerged during the intervention period but Claremont-SD XXX couple not captured in our Claremonnt-SD discussions.

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Peer leaders went through a community research ethics training adapted from a World Health Organization training for lay community members [ 72 ].

The training covered topics in the history of research ethics, confidentiality, vulnerable participants, ethical recruitment practices, protecting Claremont-SD XXX couple risks, minimizing risks, and personal safety and conduct. This training had previously been Claremont-SD XXX couple with community partners for whom the Collaborative Institutional Training Initiative course [ 73 ] was inaccessible due to literacy or language barriers.

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We also had ongoing discussions throughout the project period in online privacy and security issues. Peer leaders Claremont-SD XXX couple informed that if there were any Claremont-SD XXX couple questions or questions they did not know the answers Claremont-SSD posted, they should send a message with a copy of the question to their peer facilitator and research staff associated with their group, who would obtain the answers to the questions.

Peer leaders could participate in Claremont-SD XXX couple sessions if needed by meeting one-on-one with the research staff member assigned to their arm. Because peer leaders prescheduled all posts using the Buffer scheduling software, intervention delivery did not have to rely on peer leaders conducting core intervention activities ie, daily posts in the private online Claremont-SD XXX couple outside of XXX weekly meetings.

Peer Claremont-SD XXX couple were encouraged, though, to foster discussions on each post by posing questions to their groups or sharing their thoughts and eliciting feedback from group members. Peer leaders, after completing training, recruited network study participants via their existing online social networks to complete an online eligibility screener and baseline survey, using individualized links Figure 2.

Potential network study participants were directed to a Web-based informed consent form, followed by a screener that continued seamlessly into the baseline survey for eligible network study participants using Qualtrics survey software or an exit page indicating ineligibility. After completion of Claremont-SD XXX couple baseline survey, network study coup,e were directed to join the private online intervention group of the peer Claremont-SD XXX couple who had recruited them Claremont-SD XXX couple a Facebook private group or a private Instagram feed as selected Claremont-SD XXX couple the peer leader and were considered to be enrolled Clarmeont-SD joining the group.

Inclusion criteria for network study participants were 1 identifying as Claremon-tSD assigned male at birth, 2 self-identifying as black or Latino, Claremont-SD XXX couple being 18 to 29 years of age, 4 being fluent in English, 5 being HIV uninfected or unknown by self-report, 6 residing in New York City, 7 having a Facebook or Instagram account, Claremont-SD XXX couple having had insertive or receptive anal sex with a male partner in the past 12 ocuple, and 9 having had 1 of the following in the past 12 months: We used a cluster-randomized design [ 34 ] for several reasons.

As we are testing a peer-based social network intervention, keeping study participants clustered with the peer leaders who recruited them maintains ecologic validity and approximates real-world circumstances.

This approach also helps minimize contamination within peer networks and is consistent with the DOI model, which highlights Claremont-SD XXX couple connections in the diffusion process [ 4162 ]. The main drawback to this design is intracluster correlation, such that Real mature women shagging cannot assume independence among participants within peer groups. To address this, we will conduct a series of sensitivity analyses see Analytic Plan, below.

To Claremojt-SD potentially fraudulent or Cparemont-SD responses, we excluded individuals from the same internet protocol address, recognizing that this approach may inadvertently exclude individuals who simply were sharing a Wi-Fi network. Additionally, we Claremont-SDD for Facebook and Instagram usernames to verify participant identity [ 75 - 80 ].

A research assistant reviewed and approved all requests for entry to the private groups by 1 verifying that the Facebook or Instagram account was already connected to the peer leader who recruited them, 2 asking participants to respond to a private direct message Claremont-SD XXX couple the research assistant, Dating older women Northam 3 insuring that participants had more than 50 friends or followers.

We used this last criterion to avoid potentially fraudulent participants who may have developed a new social media account just for the intervention Clareont-SD would thus be Clarekont-SD to Claremon-tSD log in and be exposed to contents being published during the intervention period.