Abstract
South Florida is the domestic epicenter of the HIV epidemic. However, awareness of and access to preexposure prophylaxis (PrEP) remain low. This report outlines lessons learned from the development and implementation of the PrEParados model—a spatially explicit, social network–based approach designed to engage adults in PrEP. Informed by social contagion theory, the PrEParados model integrates social network and geospatial methodologies to examine participant characteristics and gather information on their friendship, sexual, and substance use networks. (Am J Public Health. 2026;116(S1):S16–S21. https://doi.org/10.2105/AJPH.2025.308333)
In South Florida—the epicenter of the United States’ HIV epidemic—men are disproportionately affected.1 However, awareness of and access to preexposure prophylaxis (PrEP) remain low among men who meet clinical eligibility for PrEP.2 Community-based participatory research (CBPR) is an impactful way to enhance engagement in HIV services including PrEP.3 Incorporating social network strategies in CBPR has improved reach and uptake of HIV testing and PrEP.4 This report outlines lessons learned from the development and implementation of the PrEParados model (model)—a spatially explicit, social network–based approach designed to engage adults in PrEP. Informed by social contagion theory, the model integrates social network and geospatial methodologies to examine participant characteristics and gather information on their friendship, sexual, and substance use networks.
STUDY OBJECTIVE
This report details lessons learned from developing and implementing the PrEParados model, a strategy to engage eligible men in HIV services.
RESEARCH OR ASSESSMENT QUESTIONS
The PrEParados model was developed using iterative CBPR in which community members and community-based staff provided feedback on community needs, resources, and preferences. In response to this feedback, the PrEParados model—described in detail elsewhere—was developed to integrate community values, three social network approaches, and geospatial information.5 We employed the social network approaches—sociocentric (friendship), egocentric (sexual and substance use), and two-mode (risk venue affiliation)—to understand the social context of PrEP-eligible men (e.g., mapping social settings or apps where alters were first connected) and to examine how network structures and processes can facilitate access to PrEP information and linkage to services. We combined this information with geospatial data to identify areas where these men are more likely to engage in behaviors associated with HIV transmission. The utility of the model has been demonstrated in numerous projects, with the most recent trial being described here.4,5
PARTICIPANTS, SAMPLE, GEOGRAPHIC LOCATION, SETTING, AND YEAR OF STUDY
The model was implemented with Latino men aged 18 years or older, living in Broward County or Miami‒ Dade County (South Florida), who met the 2017 clinical guidelines for PrEP.2 Using a modified respondent-driven sampling approach, we recruited 488 men in 130 friendship networks between February 2022 and August 2023. Participants reported their relationship with friends, sexual partners, and drug use partners. Questionnaires assessed activity engagement, including sexual, drug use, HIV prevention methods used, and discussions of HIV prevention strategies.
METHODS
We developed the model to enhance engagement with PrEP services to improve HIV outcomes through adherence to clinically advised PrEP use.2 The CBPR phases are described here and summarized in Box 1.
BOX 1—
PrEParados Iterative Framework for Strategy Development to Implementation
| Step | Purpose |
| 1. Exploring needs and receiving community feedback | Use CBPR approaches to understand community priorities, needs, and preferences. This engagement sets the theoretical foundations for the PrEParados model. |
| 2. Development and cultural tailoring of strategy components | Develop and refine the PrEParados model’s recruitment and interviewing process to be appropriate and acceptable. Through this process, the model’s materials were iteratively refined. |
| 3. Pilot testing PrEParados | Establish the utility of the model and refine study protocols, materials, and measures for next phase. |
| 4. Implementation of the model | Train staff on engaging PrEP-eligible men using the PrEParados recruitment model about the study. Collect data to capture three social network contexts (friendship, risk networks, risk venue affiliation) and geospatial information. |
| 5. Evaluation | Produce network and geospatial visualizations to inform future strategies and identify South Florida zip codes with elevated needs for HIV prevention. |
| 6. Dissemination of findings | Involve CBO staff in interpretation of evaluation findings and write-up. Develop dissemination materials for diverse audiences including academic, community, and CBO partners. |
Note. CBO = community-based organization; CBPR = community-based participatory research; PrEP = preexposure prophylaxis.
Exploring Needs and Receiving Community Feedback
The investigative team attended community forums to foster co-learning and shared decision-making throughout the model’s development and implementation. The model responds directly to the community’s needs and feedback, which highlighted the importance of using tailored strategies, scientifically grounded methodologies, and community engagement.
Development and Cultural Tailoring of Strategy Components
Informed by the community feedback, the team selected approaches that the community would find acceptable. Social contagion theory was selected as the theoretical foundation of the model as it posits that an individual’s adoption of a given health behavior, such as discussing and encouraging PrEP use, is influenced by their social context and dynamic network processes.6 The model posits that four network mechanisms—cohesion, structural equivalence, homophily, and similarities (e.g., spatial proximity, coaffiliation to venues)—influence social contagion and engagement in biomedical HIV prevention services.5–7 Community values, such as respect for friends, were incorporated into recruitment and engagement strategies. To ensure their relevance and acceptability, study materials underwent a rigorous translation process and were shared with community members and community-based organization (CBO) staff for refinement.
Pilot Testing PrEParados
From October 2018 to August 2019, we conducted a pilot test of the PrEParados model.8 This study demonstrated the feasibility of social network recruitment methods, the strength of partnering with an established and trusted community partner to facilitate recruitment, and the importance of incorporating community values into recruitment protocols and materials. Lessons from the pilot implementation allowed for further refinement of the model and identification of other social contexts where PrEP-eligible men gather. Refinements allowed for the inclusion of alters5—network members identified by initials or nicknames—across racial/ethnic groups and sexes. This expansion of the model identified HIV risk connections between men who have sex with both men and women and identified sexual partners (e.g., alters) who were unaware of HIV risks and PrEP.
Implementation of the Model
The model involves the engagement of community members to facilitate the recruitment of PrEP-eligible men. Study staff, who are members of the prioritized community, conducted tabling and distributed tailored recruitment materials at community events such as recreational sports leagues, health outreach events, and cultural events. Those interested in participating were provided information about the modified respondent-driven sampling approach used to recruit their friends as part of their sociocentric friendship network.9 Data collection used interactive platforms including Network Canvas10 (social network data), ArcGIS Survey123 from the ESRI Suite of Tools11 (geospatial data), and REDCap12 (individual survey data). Use of these platforms was critical for maintaining participant engagement throughout the 90-minute assessment.5
KEY FINDINGS
The PrEParados model gathers egocentric, sociocentric, two-mode, and geographical data to examine network composition, PrEP conversations, sexual meeting venues, and drug use among PrEP-eligible men. For the purposes of this report, we used a subsample of the study to create example visualizations that can be replicated by other teams utilizing the model or an adaptation of this approach (Figure 1).
FIGURE 1—
Examples of Visualizations That May Be Created From Data Collected Utilizing the PrEParados Model
Note. GHB = gamma hydroxybutyric acid. Part a is an egocentric network visualization examining emotional closeness and Latino ethnicity among sexual partners. Part b is a sociocentric network visualization identifying key players within a friendship network who may be engaged to deliver peer-led network interventions. Part c is a two-mode network visualization examining substance use. Part d is a two-mode network identifying where people meet sexual partners.
In the egocentric approach, participants provided information about their sexual network members (e.g., perceived ethnicity) and their relationship characteristics (e.g., emotional closeness; Figure 1a). We used egocentric analyses to understand the composition and structural characteristics of sexual networks. We employed sociocentric methods to collect information from the friendship networks and to identify key players within a friendship network who may deliver peer-led network interventions. This was done by highlighting complex dynamics such as frequency of past PrEP conversations, sexual orientation, and degree centrality of network members to assess their level of influence (Figure 1b). We used a two-mode network visualization approach to examine the affiliation among respondents with lifetime drug use and sexual meeting venues. Depicted characteristics included sexual orientation, whether the node represents a participant or a social venue or networking platforms, and degree centrality (Figure 1c and 1d). This approach was critical to identifying engagement with transmission activities and potential localities for intervention, which was further supported by the geospatial information. Geospatial visualizations used aggregate counts to highlight higher reported zones using polygons to obtain or use drugs, find sexual partners, or have sex with partners (Figure A, available as a supplement to the online version of this article at https://ajph.org).
We processed all network data with R version 4.4.1 with the TIDYGRAPH, GGRAPH, and IGRAPH packages.13 We created geospatial visualizations with the ArcGIS Online Software.11
EVALUATION, TRANSFERABILITY, AND ADVERSE EFFECTS
The PrEParados model has been applied in numerous studies, including randomized controlled trials, seeking to understand and improve HIV care and prevention engagement.4,5,14 These studies have shown the PrEParados model to be effective at engaging men, their friends, and sexual and drug use partners by surpassing recruitment goals and maintaining their engagement throughout the research process. The model was designed to understand the diversity of friendship, sexual, and substance use networks; make use of social network strategies to disseminate PrEP information (e.g., using network visualizations to understand information sharing within bounded networks in clinical trials); and leverage community partnerships to enhance PrEP engagement among a priority community. Utilizing the model, researchers can characterize the social contexts of individuals at elevated susceptibility for HIV acquisition and examine network mechanisms that may influence engagement in PrEP services.
SCALABILITY
Two key factors support the scalability and sustainability of the PrEParados model. First, the model was developed in partnership and continues to be supported by a trusted CBO and a mobile PrEP program. This model relies upon engaging and hiring community members as study team members and champions. Grounding an intervention in the community using CBPR approaches can facilitate the program’s sustainability and long-term success.3,15 Second, many of the resources needed to implement the model are readily available. Network Canvas (data collection) and R (analysis) are free to use, with training and user resources publicly available. Other data collection platforms, such as REDCap and the ArcGIS suite, are often available through academic institutions. Although not an outcome of the current phase of the model, future implementation will involve costing activities to examine cost-effectiveness of this model to further support its sustainability and scalability. To ensure community involvement throughout all phases of the research, CBO staff participated in interpreting data collected through the PrEParados model. As part of this collaborative process, CBO staff codeveloped peer-reviewed manuscripts, community presentations, and academic conference presentations. The model was intentionally designed to center the community’s voice while identifying strategies to improve HIV-related outcomes including increased PrEP knowledge and adherence. By sharing the model and its findings directly with community members, CBOs, and practitioners, this approach accelerated the translation of academic research into practical health improvements. Direct dissemination was prioritized to help reduce persistent health inequities stemming from limited access to resources.
PUBLIC HEALTH SIGNIFICANCE
The PrEParados model has demonstrated effectiveness in engaging PrEP-eligible men in South Florida. Its adaptable design allows for implementation in other settings and among different populations, supporting efforts to improve HIV outcomes in communities disproportionately affected by the epidemic. By ensuring that effective interventions reach those who stand to benefit most, the model contributes to reducing HIV-related health disparities.
ACKNOWLEDGMENTS
The research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award R01MH125727 (PI: Kanamori) and R01MH125727-S1 (PI: Kanamori; supplement scholar: Rodriguez), and by the University of Miami’s Center for HIV and Research in Mental Health (CHARM; P30MH133399 [National Institute Of Mental Health & National Institute of Allergy and Infectious Diseases]).
We extend our gratitude to those who participated in this study including study staff, community members, and respondents, without whom this research would not be possible.
Note. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
CONFLICTS OF INTEREST
The authors have no conflicts of interest to disclose.
HUMAN PARTICIPANT PROTECTION
The project was approved and monitored by the University of Miami institutional review board, project 20201269.
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