Discussion
nausea
Engaging vulnerable populations, who are seeking primary care services in the ED, into prevention services to preserve their sexual and reproductive health is necessary. Mobilizing innovative approaches to extend PrEP access and promote PrEP uptake is an engagement approach with potential to actualize a meaningful decrease in new HIV cases at the population level. To our knowledge, and based on an extensive literature review, this is the first pilot study in the US to initiate a RCT aimed at increasing willingness for PrEP followed by an actionable step, a real-time linkage to a PrEP clinic from the ED visit. This is also the first RCT to move beyond assessing knowledge and attitudes about PrEP among cisgender Black women. The research process here builds self-efficacy for cisgender Black women to access PrEP within a 72-h period by scheduling an appointment in real-time, during an ED visit, with culturally-competent healthcare providers who are ready to initiate PrEP access and uptake. Study findings presented here make a significant contribution to the growing body of literature aimed at increasing PrEP uptake among HIV-vulnerable populations.The iPrEP intervention was superior to usual care at increasing knowledge about PrEP to enrolled participants. Essentially, those who did not know about PrEP before the study were much more likely to know about it after the study if they received the iPrEP intervention, rather than usual care. Previous qualitative research approaches found a correlation between informing cisgender women about PrEP and positive increases in PrEP attitudes and interest [As the iPrEP intervention, with 99-unique questions, contributed to an increase in willingness to use PrEP among 69% of 15 cisgender Black women during a single-arm development study [Apart from findings on willingness, we discerned an intervention effect regarding knowledge. Participants had higher knowledge at follow-up when compared to baseline. Importantly, knowledge was higher among participants randomized to iPrEP (94%) compared to those randomized to usual care (87%). However, the chance of demonstrating PrEP knowledge at follow-up was different for individuals who reported no PrEP knowledge at baseline. Chandler et al. developed a pilot PrEP education intervention and enrolled 43 Black college women. Their study findings illustrated that 67% of the cohort had not heard about PrEP and some (72%) were apprehensive to initiate PrEP; however, 67% of enrolled participants found the intervention useful and self-reported an increase in knowledge [Participants in the usual care group reported a higher level of readiness for PrEP uptake than individuals who received the iPrEP intervention. Participants who received the iPrEP intervention learned more about the nuances of PrEP uptake, with specificity to side effects that can impact liver function, cause nausea, and possibly have a negative effect on bone density. Individuals in the usual care arm did not receive this information at all. Thus, each group made decisions about readiness based on different information. Hirschhorn et al. stated that 81.1% of their participants had concerns about taking PrEP with side effects as a common concern [We implemented a new and actionable step that afforded the opportunity to translate PrEP knowledge, willingness, and readiness into an action, an initial PrEP clinic visit. The warm hand off process was based on the standard of care referral process for clinical care. Individuals who receive care in the ED are routinely referred to other clinical care settings for follow-up care [Although the findings of the pilot RCT did not prove the null hypothesis, the warm hand-off process was deemed feasible and largely acceptable by the participant population. Hill and Coker affirmed that the ED is an ideal clinical environment for brief interventions that promote sexual health among cisgender Black women presenting with nonemergent health conditions [