From Tanzania to Washington, DC: Application of the Consolidated Framework for Implementation Research and ADAPT-ITT...

While HIV incidence in Washington, DC has declined overall, significant racial disparities persist. Pre-exposure prophylaxis (PrEP) remains underutilized among Black adults due to multiple barriers including medical mistrust, stigma, and structural barriers to access. Using the Consolidated Framework for Implementation Research (CFIR) and ADAPT-ITT model, we conducted in-depth interviews with opinion leaders (n = 28) including community-based organization leaders, health department representatives, healthcare providers, and current/potential PrEP users to guide the adaptation of a community-based HIV treatment intervention from Tanzania to create a community-based PrEP intervention for Black adults in Washington, DC to address the aforementioned barriers. Data analysis employed thematic content analysis with CFIR construct mapping to identify implementation barriers and facilitators. Key implementation facilitators included: mobile service delivery in high-need areas (Wards 7-8), comprehensive health service integration, culturally matched staffing, flexible evening/weekend hours, and multi-channel outreach via social media and community venues. Major barriers included privacy concerns in mobile settings, social determinants of health challenges, and multilayered stigma. Drawing on these findings, we developed the adapted cbPrEP intervention with the six components featuring: (1) mobile service delivery platform, (2) comprehensive service integration, (3) community-centered staffing model, (4) privacy and confidentiality protocols, (5) multi-channel outreach strategy, and (6) wraparound support services including insurance navigation. This study demonstrates the value of using implementation science frameworks to adapt evidence-based interventions while centering community voices. The resulting cbPrEP intervention model shows promise for increasing PrEP access among Black adults in Washington, DC through culturally responsive, community-based service delivery.