PROJECT ABSTRACT Efforts to curb the HIV epidemic in the United States (US) are impeded by suboptimal access and adherence to antiretroviral therapy (ART), particularly among cis-gender Black women with HIV (CgBWH) in the Southern US who have lower care linkage, engagement, and viral suppression, and higher mortality, than their male and White female peers. Long-acting (LA) ART has the potential to transform the HIV treatment landscape, but the uptake of LA-injectable (LAI) ART has been low due to multi-level challenges and the lack of tailored approaches for key groups, including CgBWH. To help fill this gap, over the past six years our multidisciplinary team has led mixed methods research on women’s LA ART interest, preferences, barriers, and facilitators. However, these data were collected prior to LA ART approval, queried hypothetical use, and did not include young women or focus on the South. To realize the Ending the HIV Epidemic (EHE) initiative “Treat” pillar, we must develop novel approaches to optimize and tailor care linkage and ART adherence strategies for CgBWH. This proposal builds on our existing multisite research infrastructure and robust academic-community partnerships to explore Southern CgBWH preferences and implementation challenges in the era of approved LA ART; it will integrate stakeholders’ needs and values to co-create prototype tools for education, referral, and linkage to HIV treatment tailored to CgBWH. We will leverage the Study for Treatment And Reproductive Outcomes (STAR) infrastructure, that is currently enrolling 1200 CgBWH in six Southern sites including urban and rural EHE priority jurisdictions (AL, FL, GA, MS, NC, DC). To advance this work, we will use the Consolidated Framework for Implementation Research and Human-centered design to inform our data collection, analyses and the development of educational, referral, and linkage prototype toolkits to support CgBWH LA ART access and use. In Aim 1 we will examine CgBWH preferences, facilitators, and barriers to LA ART uptake and novel delivery via an ongoing LA ART survey in STAR (n=1200 CgBWH) and longitudinal interviews with 120 CgBWH who vary by adherence, LA ART use, age, and rurality. In Aim 2 we will identify strategies to equitably scale up LA ART for CgBWH through interviews with 60 HIV service providers including from community-based organizations (CBOs) that vary by role, LA ART availability, funding, and rurality. In Aim 3 we will use human-centered design approaches via a series of 3 workshops across four CBOs (2 rural, 2 urban) to integrate the voices of CgBWH and HIV service providers and iteratively develop LA ART educational, referral and linkage tools that are tailored, acceptable and feasible for CgBWH and a range of delivery sites. Given our established academic-community research infrastructure, clinical leadership in LA ART programming, and expertise in HIV and women’s health, qualitative methods and implementation science, we are well-posi...