PrEP 4 Her: Developing a Novel Strategy to Implement PrEP into Women's Healthcare

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PROJECT SUMMARY HIV disproportionately affects Black cis-gender women, especially in the Southern United States (US). HIV pre- exposure prophylaxis (PrEP) was approved by the FDA in 2012 and is an effective prevention tool able to decrease HIV transmission up to 92% among cis-gender women. However, there has been minimal PrEP uptake among racial minority groups and inequitable utilization in the South. With implementation of behavioral interventions, primarily focused on demand creation (i.e. community distribution, scheduling PrEP appointments during events celebrating gay pride, etc.), PrEP utilization among almost all groups except Black cis-gender women has improved. Given these inequities, there is an urgent need to better understand how to improve PrEP utilization among Black cis-gender women in geographic locations with the greatest need, like the South. Black cis-gender women have significant individual-level barriers to PrEP utilization, including but not limited to low HIV/PrEP knowledge, PrEP stigma, and low perceived need. Programs to implement PrEP in Title X family planning clinics, where cis-gender women already receive routine care, provide attractive venues to improve access. However, in PrEP implementation studies at these clinic sites, while improvement in provider-knowledge and PrEP referrals occurred, PrEP uptake was still low when on-site services were not available. While more research is needed to improve PrEP access in family planning clinics that specialize in women’s healthcare, in states like Alabama, where clinics receiving Title X funding are currently not providing PrEP services, additional strategies are needed. Gynecology clinics offer an ideal setting for PrEP care as a part of routine reproductive and sexual health care. Gynecologists already provide primary health care services for many cis-gender women, oftentimes in place of a primary care provider, making this clinic setting ideal for integration of PrEP services tailored for Black women. Our implementation study is informed by compelling preliminary data from almost 800 Black cis-gender women living in Alabama using discrete choice experiment methodology, which determined their desired PrEP services would be delivered in a clinical care setting by a gynecologist, rather than telehealth or pharmacy based programs. The proposed study will pursue three specific aims: (1) Evaluate key determinants for implementation of PrEP into gynecology clinic settings through concurrent mixed-methods; (2) Develop and refine a multi-component implementation strategy to integrate PrEP in routine women’s health visits (i.e. PrEP4Her) and (3) Pilot PrEP4Her at a gynecology clinic. We will measure implementation outcomes grounded in the RE-AIM framework, incorporating constructs from Proctor et al, including: reach, efficacy, acceptability, fidelity, adoption and preliminary effectiveness. Upon completion of our proposed research, our inter-disciplinary team, which includes experts in infectious diseases, implementation science, community-engaged research and psychology, will be primed to lead a multi-site type III implementation trial of PrEP service delivery at gynecology clinics across the South.