Table 1.

Just4Us Module Descriptions

Objectives/Goals	Topics/Theoretica/ Construct	Module Activities
Module 1: Just4Us is just for me: taking care of ourselves now and for our future
Ensure participants understand overarching theme of Just4Us and know what is going to happen during the session	Promote favorable attitudes toward PrEP	Begin with a short deep breathing exercise, which is also offered as a tool to assist with emotion regulation.
Establish rapport using client-centered approach	Promote PrEPself-efficacy: PrEP may be one strategy she can use to stay healthy	Brainstorm theme of Just4Us, connect theme to participant’s overall health goals, and discuss potential barriers.
Identify participant’s health goals and obstacles, provide encouragement, and reinforce Just4Us empowerment theme		Tablet used to create a word cloud from responses to “What does Just4Us mean to you?” Word cloud is revisited at the end of intervention.
Connect participant health goals with the goals of the intervention		Individualized action plan to stay healthy is introduced to record ideas generated through modules.
Skill-building for emotion regulation, as strong emotions can be a possible barrier to health actions, including PrEP
Module 2: Knowledge is power: learning how PrEP can protect me against HIV
Increase PrEP awareness and basic knowledge by providing standardized information via a women-focused PrEP video, which includes role modeling PrEP acceptance by peers	PrEP awareness, knowledge, self-efficacy, stigma, norms	Participant watches an 8-min animated video with 3 women discussing PrEP and several providers who offer additional information about PrEP. Participant checks off topics she hears about on the video as she watches. Check sheet reviewed and positive feedback provided.
Reinforce knowledge with active watching activity	Perceived need for PrEP	Teach-back activity: Participant shares her PrEP knowledge with female friend, through a role-play.
Increase comfort in talking about and asking questions about PrEP	Communication about PrEP (with partners and providers, other women)
Introduce topics covered in greater details in later modules	Integrating PrEP with women’s overall sexual and reproductive health (e.g., continued need for STI protection)
Knowledge reinforcement
Module 3: Mirror talk: checking my chances of getting HIV/STIs
Identify what increases or decreases one’s likelihood to be exposed to HIV/ STIs	Address awareness of behaviors that increase or decrease chances of being exposed to HIV and STIs	Participant categorizes predetermined statements as increasing or decreasing likelihood of HIV exposure and discusses reasons. Laminated words/phrases (e.g., had sex while drunk, or used a condom during vaginal sex) are placed on a board under two headings (increase/ decrease likelihood).
	Perceived risk/vulnerability to HIV	Additional suggestions elicited from participant as strategies she may use to reduce the likelihood of acquiring HIV/STIs.
Module 4: One size doesn’t fit all: my personalized options for HIV/STI prevention
Increase awareness of and knowledge about PrEP in relation to other modalities of HIV prevention and other STIs	PrEP Knowledge	Participant is given a safe sex “toolkit” (laminated pictures or words) and asked to choose HIV/STI prevention strategies that have been helpful/have been used in the past and strategies they plan to use/would consider trying, including PrEP.
Distinguish PrEP from pregnancy prevention	Distinguish PrEP from other HIV/STI prevention strategies
Increase knowledge and discuss the use and safety of PrEP regarding contraception and pregnancy	PrEP not for pregnancy prevention
Knowledge reinforcement	Difference between PrEP and PEP
	Importance of using PrEP with other HIV/STI prevention strategies
Modules 5 and 6: How to make PrEP part of your life: strategies to manage what you and others think about PrEP
Increase awareness of their beliefs about PrEP	PrEP behavioral and normative beliefs	Three tablet activities on several behavioral/stigma beliefs. Participant picks one statement she most agrees with within each group of beliefs. C-N selects appropriate MI strategy to discuss beliefs with participant.
Address unfavorable beliefs and promote favorable beliefs about starting PrEP in the next 3 months	Women’s PrEP Stigma	Two tablet activities on normative beliefs. First, the participant selects someone who would support her starting PrEP, then someone who would get in the way of her starting PrEP. C-N discusses strategies for effective communication with others about PrEP.
Address stigma from others	Self-efficacy for communication about PrEP to others	Deciding about talking to others about PrEP (it is her choice). Participant is provided with communication strategies with the possibility she may encounter some initial resistance, followed by a scripted role-play activity to practice those strategies.
Build skill to communicate about PrEP with others (family, friends, partners)	Negotiating sexual safety and negotiating pregnancy intentions with partner	If a participant expresses concern for a strong negative response, e.g., from partner, she is given appropriate referrals for intimate partner violence (IPV).
Use motivational interviewing strategies, including reflective listening, summarizing, change talk, and other strategies when encountering ambivalence or resistance
Module 7: It’s bigger than me: acknowledging things that interfere with my taking PrEP
Identify structural vulnerability factors that may interfere with individual PrEP uptake	Identify structural vulnerability factors, including time/schedule around work, school, treatment program; childcare responsibilities; lack of money or health insurance; transportation; food insecurity; homelessness/lack of housing; etc.	Tablet activity showing road to PrEP and possible barriers, allowing participant to identify personal challenges. C-N provides appropriate local resources* that they can access and discusses a plan for accessing specific resources.
Identify resources for those vulnerability factors	Identify structural resources	*The C-N has access to a large file of appropriate city-specific resources.
Develop plan to use the resources and address the vulnerabilities	Acknowledge how such factors can interfere with or promote staying healthy/starting PrEP
	Provide information about local resources to address particular issues/concerns
Module 8: I got this: building skills to get PrEP
Providing knowledge and skills development in all the steps needed to access PrEP from a provider	Review steps on the PrEP roadmap, including all steps before the health care provider visit, at the visit and after the visit	Using the tablet, the C-N shows the participant a “roadmap to PrEP” with all the necessary steps surrounding a visit with a health care provider (e.g., identify a provider, call for an appointment), during the visit (e.g., talk about sex and drug use with provider) and after the visit (e.g., get lab work done, get prescription filled).
Build communication skills with health care providers	Self-efficacy for starting PrEP	In-depth conversations and role-plays include contacting a provider and ways to talk to providers.
Address access to health care, including how to pay for PrEP		Handouts provided: printed roadmap, insurance information about PrEP, local list of providers and contact information, provider cheat sheet (key points for provider conversation).
Address stigma from others in the health system		C-Ns reference and build upon their positive beliefs, skills, and structural resources they can use to access PrEP.
Module 9: Make it happen: the call to start PrEP
Develop skills around the health care systems	Self-efficacy for starting PrEP	Extends discussion of providers. The C-N works with participant to choose a provider, either from the list or her own provider if preferred. Discusses comfort about talking with selected provider about PrEP. C-N offers opportunity to make appointment just then during the session and if so, completes a PrEP appointment card.
Module 10: Tracking back: let’s review what we’ve learned about PrEP
Reinforcement of objectives and goals of previous modules, especially Module 8	Knowledge reinforcement, self-efficacy for PrEP initiation	C-N reviews materials in tote bag/ health information with participant. Encourages beneficial health habits.
General health information included in packet (as decoy to avoid PrEP stigma and as a resource for women to help promote their health in general)		Discusses safety of taking materials home and any negative repercussions participant may face. Makes appropriate referrals or initiates IPV standard operating procedure (SOP),* as needed.
		*IPV SOP—procedures for addressing women in immediate harm
Module 11: Why is my phone buzzing? Text reminders for PrEP
Present text message adherence program	Cues to action from the Health Beliefs Model	C-N explains text messaging application and enrolls participant. Participant creates her own messages, which do not directly reference PrEP. Weekly messages sent until participant starts PrEP and then daily messages begin. C-N sends test message to participant’s mobile phone to verify participant can receive messages and can identify the Just4Us phone number.
Enroll participant in the text messaging (participants can opt out of the text messaging component if they choose to do so)
Module 12: Onward and upward: my plan for PrEP
Reinforce the plan	Reinforcement of knowledge and selfefficacy; reiterate empowerment theme	C-N expresses appreciation to participant for considering PrEP, reinforces action plan, and explains follow-up phone calls.
		Revisits the Word Cloud from Module 1 on the tablet. Emails or texts the Word Cloud to the woman if she would like it.
Follow-up phone calls—C-Ns make up to four phone calls to assist participant in accessing PrEP
Assist participant to overcome actual barriers she may encounter when she attempts to access PrEP	Self-efficacy to overcome personal and structural barriers to initiating PrEP and staying on PrEP	C-N assesses where woman is in relation to all the steps in PrEP roadmap, supports actions taken, identifies and problem solves in relation to barriers.

Note. Italicized text = theoretical constructs. C-N = counselor-navigator; MI = motivational interviewing; PEP = postexposure prophylaxis; PrEP = pre-exposure prophylaxis; STI = sexually transmitted infection.