Adaptation of an HIV Prevention Ambassador Program Developed in Africa for Use With Cisgender College Women in the United States: Formative Study.

Background: Cisgender college women are vulnerable to HIV transmission but rarely use biomedical prevention tools such as pre-exposure prophylaxis (PrEP). In the Orlando Metropolitan Statistical Area (MSA) of Florida, HIV vulnerability is elevated given the area's high incidence rate (sixth among US cities). Increasing HIV and PrEP knowledge among cisgender college women can curb HIV incidence. One method of providing HIV education to cisgender college women and addressing the HIV and PrEP-related stigma is by training ambassadors through programs such as Maximizing Options to Advance Informed Choice for HIV Prevention (MOSAIC), which was developed for women and girls in Africa. Objective: The research aim was to adapt the existing MOSAIC HIV prevention ambassador program to reflect the needs of cisgender college women in Orlando MSA and to determine its acceptability, appropriateness, and feasibility for this population. Methods: The assessment, decision, administration and adaptation, production, topical experts, integration, training, and testing (ADAPT-ITT) framework for adapting evidence-based interventions guided the research. Cisgender college women (n=12) participated in focus groups that included theater testing, discussion, and surveys. Program materials were revised based on feedback, then reviewed by topical experts (n=5) who assessed feasibility and appropriateness. Data analysis was iterative; qualitative data were analyzed using rapid methods, and descriptive survey statistics complemented findings to inform curriculum revisions. Ambassadors (n=7) were trained with the adapted curriculum and provided data on acceptability and appropriateness. Results: Data from cisgender college women and topical experts indicated the program's acceptability (mean 5.0, SD 0), appropriateness (mean 4.95, SD 0.06), and feasibility (mean 4.95, SD 0.10) and informed program adaptations. Themes from the qualitative data indicated the value of the ambassador program as well as the following recommendations: (1) provide more guidance for activities, (2) add HIV and PrEP information specific to the target population, (3) prioritize interpersonal engagement, and (4) emphasize ambassador wellness. Ambassadors reported high levels of acceptability (mean 4.75, SD 0.66) and appropriateness (mean 4.86, SD 0.38) for the adapted program after being trained and reported increases in confidence in some areas. Conclusions: Study findings provide preliminary support for the acceptability, feasibility, and appropriateness of the adapted ambassador training program. Further testing of the program can determine its use as a scalable, peer-led strategy to address HIV vulnerability and PrEP stigma in metropolitan areas with elevated HIV incidence, such as Orlando MSA.