SPIRIT checklist.

<div> Black girls are disproportionately impacted by HIV and STIs in the United States. Black male caregivers are underutilized in family-based HIV/STI prevention programming and offer a novel opportunity to protect Black girls. This study will evaluate the efficacy and implementation of an HIV/STI prevention program delivered to Black girls and male caregivers in community settings. IMAGE: <u>I</u>MARA for the <u>M</u>ale Caregivers and <u>G</u>irls <u>E</u>mpowerment was adapted from IMARA, an evidence-based mother-daughter intervention to decrease HIV/STI infection and increase communication and healthy relationships among girls and their male caregivers. Using an efficacy implementation design, we will test the effectiveness of IMAGE compared to a time-matched general health promotion program across six community-based organizations. Aim one will evaluate IMAGE in a 2-arm randomized controlled trial with 300 14-18-year-old Black girls and their male caregiver dyads in Chicago, IL. We hypothesize that girls who receive IMAGE will have lower STI incidence (<i>primary outcome),</i> fewer sexual partners, and more consistent condom use (<i>secondary outcomes</i>) at 6- and 12-months compared to girls in the health promotion program. Guided by the 3-Step Implementation Model, our second aim is to identify and describe factors (barriers, facilitators) and processes affecting implementation in community settings. HIV and STI disparities go beyond individual-level factors, and male caregivers may protect girls by being a sexual health resource. This study will facilitate rapid CBO uptake and ownership of IMAGE if effective. <b>Trial Registration:</b> ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT06266416" target="_blank">NCT06266416</a> </div>