An Interactive Systems Approach to Ending the HIV Epidemic Among Women in Atlanta

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ABSTRACT Supply and demand constraints have affected PrEP scale-up for cisgender women in the Southern US. PrEP use requires ensuring that cisgender women who can benefit from PrEP are aware of it (i.e., demand side) and ensuring PrEP is accessible in settings where cisgender women seek care (i.e., supply side). Anchoring PrEP care to Title X-funded family planning services that cisgender women already trust, access routinely, and deem useful for their sexual health is of great appeal, as it offers an ideal opportunity to reach women who may benefit from PrEP. In Georgia, the state with the highest rate of new HIV diagnoses, our work demonstrates that many Title X family planning clinics do not provide PrEP. Our research also shows low PrEP awareness and use among Atlanta cisgender women. Further, our Atlanta-based family planning-focused PrEP implementation research indicates that even when FP clinics offer PrEP, few cisgender women uptake PrEP, and providers note continued discomfort with screening, recommending and counseling about PrEP. Lessons learned from HPV vaccine and contraception rollout demonstrates that awareness and availability alone may not be sufficient; moving cisgender women from PrEP awareness to uptake demands alternative delivery models, inclusive of women's perspectives, to overcome other factors impeding women from using PrEP. Improving PrEP reach among cisgender women may therefore require more effectively engaging them in the development of appropriated and acceptable patient-centered PrEP care approaches to support uptake. In the proposed project, we will (Aim 1) use the Interactive Systems Framework to employ tailored implementation strategies informed by our extensive prior work to support PrEP adoption and implementation across Atlanta Title X clinics (addressing supply-side barriers); (Aim 2) use an evidence-based Community Organizing Approach to raise awareness, interest, and connection to PrEP among cisgender women (addressing demand- side barriers); and (Aim 3) innovatively use human centered design (HCD), a patient-centered methodology that brings bringing end-users and developers together to co-create care delivery strategies, to bring Southern women's voices into the development of PrEP care delivery strategies. Given limited research pertaining to strategies to increase PrEP reach among cisgender women in the South, findings from each aim will independently fill numerous gaps for optimizing clinic and community strategies to strengthen HIV prevention for Southern women. Given our collaboration with Georgia Family Planning System (Georgia's Title X grantee), Atlanta area Title X clinics, and robust partnerships with sexual health CBOs (led by SisterLove), we are uniquely positioned to mount a coordinated approach across diverse Atlanta counties built around our clinic- academic-CBO collaboration to strengthen HIV prevention for women, and importantly, to create a sustainable systems approach to move new HIV prevention (and sexual health) innovations more quickly to women.