Becoming one with the community: a grounded theory-derived context-specific framework exploring AIDS service organization strategies for implementing pre-exposure prophylaxis outreach among African American populations

Although pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention approach, uptake remains low among African American individuals within the United States (US). AIDS service organizations (ASOs) may foster effective PrEP outreach among this underserved population. However, strategies for engaging priority African American groups are limited. This study developed a context-specific framework for tailoring ASO-based PrEP outreach for African American high priority groups for HIV. This study utilized constructivist grounded theory (CGT) rooted in symbolic interactionism and pragmatism. One-on-one, semi-structured interviews were conducted with key ASO informants in the US to explore the meanings ascribed to PrEP outreach and associated processes. CGT analytic principles, including line-by-line coding, focused coding, and theory building, were used to identify emerging themes and develop a framework grounded in successful outreach among African American priority groups. A total of 10 eligible participants from ASOs across six US cities were included in this study. Successful implementation of PrEP outreach with African American groups was described as a multi-phased, dynamic process termed “becoming one with the community.” This context-specific framework, grounded in participants’ lived experiences, involved three overlapping phases: (1) grappling with client and staff pushback and other challenges, (2) transforming these challenges into opportunities, and (3) establishing an authentic ASO presence within the community. The participants detailed key ASO strategies for building trust and ensuring culturally responsive PrEP outreach within African American priority groups. ASOs are central to promoting PrEP engagement among high-priority African American populations. This context-specific framework can inform improved outreach efforts for other ASOs working with similar groups.