Masibambane (Let Us Work Together), Ladies Chat: Pilot Evaluation of an Online, Gender-Enhanced, Group-Interactive Workshop to Promote Oral PrEP to Young South African Women.

Oral pre-exposure prophylaxis (PrEP) has been available to adolescent girls and young women (AGYW) in the South African public sector since 2019, yet uptake has lagged below targets. In this pilot trial focused on early PrEP cascade steps, a WhatsApp^®-based small-group interactive intervention with a gender-empowerment component- "gender enhanced" (GE)-was compared to a control condition providing website links to PrEP information/motivation that women accessed individually ("individual access", IA). PrEP was not offered as part of the trial. Eligible participants were 18-25 years, heterosexually active in the past six months, but not pre-screened for PrEP eligibility. Primary outcome was undergoing individual PrEP counselling; secondary outcomes were HIV testing and self-reported PrEP initiation. Fifty women enrolled in each condition (N = 100). Retention, feasibility and acceptability were high. Fifty-six percent underwent PrEP counseling in each condition; PrEP was initiated by 8 women in GE and 5 in IA. Stage of change (readiness) for PrEP increased more in GE than IA women post-intervention (b = 0.68 [95%CI = 0.25, 1.11, p = 0.002]) and at 3-month follow-up (b = 0.73 [95%CI = 0.18, 1.27, p = 0.009]). GE women showed greater improvements in PrEP knowledge and positive PrEP beliefs, had less decline in perceived HIV risk, and greater reduction in perceived importance of family's opinions about sexuality/reproductive health. In a setting where women were not given immediate access to PrEP, a large proportion took a behavioral step for initiation. Especially as other forms of PrEP become available, both the GE intervention and the IA control conditions merit further refinement and testing in a larger trial.