From Global to Local: Adapting an HIV Prevention Ambassador Program Developed in Africa for College Women in the United States (Preprint)

BACKGROUND 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 (6th among U.S. cities). Increasing HIV and PrEP knowledge among college women can curb HIV incidence. One method of providing HIV education to college women and addressing the HIV and PrEP-related stigma is by training them to share information with their peers. OBJECTIVE The research aim was to adapt an existing HIV prevention ambassador program developed for girls and women in Africa to reflect the needs of college women in Orlando MSA. METHODS The ADAPT-ITT framework for adapting evidence-based interventions guided the research. 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 during a pilot test of the adapted curriculum and provided data on acceptability and appropriateness. RESULTS Data from college women and topical experts indicated the program’s acceptability, appropriateness, and feasibility and informed program adaptations. Ambassadors reported high levels of acceptability and appropriateness for the adapted program after being trained and reported increases in confidence in some areas. CONCLUSIONS Study findings support the adapted ambassador training program as a scalable, peer-led strategy to address HIV vulnerability and PrEP stigma in metropolitan areas with elevated HIV incidence, such as Orlando MSA.