Community-Partnered Development of Behavioral Economic Incentives in a Pre-exposure Prophylaxis Intervention for Transgender and Nonbinary Clients in Los Angeles

Background This article describes our community-engaged process of incorporating culturally relevant, non-monetary, chance-based incentives into a transgender and gender nonbinary (TGNB) oriented pre-exposure prophylaxis (PrEP) intervention called PrEP Well . Methods PrEP Well , a single-group longitudinal observational study design, was developed as a community-led, multicomponent HIV prevention intervention that combines peer navigation and fixed monetary incentives for research activities in a TGNB community health center. Recruitment for PrEP Well began in April 2022. We added prize-based behavioral economic incentives to PrEP Well on April 25, 2023. These prizes reflect the TGNB community’s interests through input from a transgender community advisory board, surveys of health center clients, and partnerships with local TGNB-owned businesses. Data are drawn from program administrative records, surveys, and qualitative interviews with program recipients. Comparisons between prize selection were assessed via Chi-square tests. Qualitative interviews were analyzed via inductive thematic analysis. Results Before implementation, survey respondents found additional incentives for participation in PrEP Well were highly acceptable. After the incentives were implemented in PrEP Well , qualitative data from exit interviews highlighted the motivational impact of combining a fun, chance-based incentive model with the empowering ability to choose from a variety of trans affirming non-monetary incentives. Conclusions Our community-partnered approach integrated behavioral economic incentives into a TGNB-oriented PrEP intervention. The participants found the additional community-relevant prize-based incentives to be acceptable and motivating. Future research should explore the immediate and long-term outcomes of this approach, and its scalability with diverse TGNB populations, to promote equity in HIV outcomes.