DYnamic decisioN Support for IntegrAting PrEP in Clinics for Young People in Alabama and Botswana

This study evaluates strategies to improve access to HIV prevention through the integration of pre-exposure prophylaxis (PrEP) into existing healthcare settings, rather than limiting delivery to specialty clinics. The study addresses barriers to PrEP uptake, including limited awareness, stigma, and restricted access, and recognizes that availability alone may not ensure initiation or sustained use. The study includes two components. First, a longitudinal cohort of current PrEP users will be followed to assess changes in access, preferences, and PrEP use over time in real-world settings. Second, a dynamic decision-support toolkit will be developed and evaluated to support patients and providers in PrEP-related decision-making. The toolkit will include patient- and provider-facing components to support clinical decision-making, improve risk understanding, and facilitate integration of PrEP into routine healthcare. The toolkit will be refined and beta-tested in selected healthcare facilities in Botswana and Alabama.

Group 1 * Inclusion for Alabama site: * 18 years of age or older * Currently using or eligible for PrEP * Inclusion for Botswana site: * 18 years of age or older * Participated in the parent Tshireletso study in Botswana * Exclusion for both sites: * Under the age of 18 * HIV positive Group 2 * Inclusion for both sites: * 18 years of age or older * Currently working as PrEP providers or clinic administrators at outpatient clinics * Exclusion for both sites: * Under the age of 18 Group 3 * Inclusion for both sites: * 18 years of age or older * Currently working as policy makers or program leaders at outpatient clinics * Exclusion for both sites: * Under the age of 18