PROJECT SUMMARY One in five new HIV diagnoses in the United States (US) are in women. Driven by the social and structural determinants of health ((SSDH), i.e., institutional and systemic racism and inequity), the HIV epidemic disproportionately affects Black women in the South. HIV pre-exposure prophylaxis (PrEP) with oral tenofovir disoproxil fumarate/emtricitabine decreases risk of HIV acquisition by over 90% in cisgender women. However, PrEP uptake in US women has lagged, with only 2% of women who may benefit from PrEP receiving a prescription in 2016. The overall objective of this proposal is to explore patients' preferences for HIV prevention education and counseling, with the inclusion of the DST during the healthcare visit and information about the SSDH, particularly structural traumas that may increase HIV vulnerability. The parent R01 award uses a multilevel approach to offer PrEP through a patient-level intervention—an HIV prevention decision support tool (DST); a provider-level intervention—training on shared decision-making; and a clinic-level intervention—training on trauma-informed care, to ultimately mitigate disparities in the HIV epidemic. The proposed administrative supplement will support training and career development for an emerging Black woman scholar, Dr. Rachel Logan, to explore the SSDHs that impact Black women's decisions around HIV prevention use, including PrEP. This study will occur at a reproductive health clinic in Duval County, Florida, where HIV incidence in women is high. Aim 1: Participants will be randomized to an HIV prevention DST coupled with standard counseling or standard counseling alone to evaluate the effect of the DST on PrEP prescriptions and patient experiences of PrEP care and counseling. Aim 2: A 3-phase approach will evaluate how provider training on shared decision making and clinic-wide training on trauma-informed care affect patient counseling and decision making about PrEP. Baseline data collected in Phase 1 will be compared to data collected after the training without use of the DST (Phase 2), and to data collected after the training with use of the DST (Phase 3). Aim 3: The feasibility of disseminating the multilevel interventions described in Aims 1&2 will be assessed using the Consolidated Framework for Implementation Research, providing preliminary data on implementation. We propose using the Public Health Critical Race Praxis (PHCRP) framework to explore messaging about SSDHs, enhance the provider- and clinic-trainings, and improve patients' care experiences and outcomes. This contribution will be significant because it centers Black women in the health care context and elicits their perceptions and experiences to address persistent inequities in HIV.