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Pitchford K, Shangani S, Dawson C, Masa R, Heron K. Community Health Care Providers' Perspectives on Human Immunodeficiency Virus Pre-Exposure Prophylaxis Use Among Black Women in Eastern Virginia. AIDS Patient Care STDS 2024; 38:123-133. [PMID: 38471092 DOI: 10.1089/apc.2023.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
The most at-risk population among women for human immunodeficiency virus (HIV) diagnosis in the United States are Black women, accounting for 61% of all new HIV cases. Pre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention method for people at risk of HIV acquisition. Although disproportionately affected by HIV, Black women's knowledge, perceived benefits, and uptake of PrEP remain low. The socioecological model (SEM) may be useful for understanding why there is a low uptake of PrEP among Black women. The current study used the SEM to explore provider perspectives on the barriers and facilitators of PrEP uptake among Black women in Eastern Virginia. Semistructured interviews were conducted with a total sample of 15 community health care providers. Barriers of PrEP uptake at the societal (e.g., PrEP advertisements focus on gay men), community/organizational (e.g., time constraints in the workplace), interpersonal (e.g., perceived monogamy), and individual (e.g., unmet basic needs) levels were identified. Providers also identified facilitators of PrEP uptake at the societal (e.g., PrEP advertisements that target women), community/organizational (e.g., PrEP education), interpersonal (e.g., HIV-positive partner), and individual (e.g., PrEP awareness and perceived susceptibility to HIV) levels. These findings highlight unique barriers to accessing and taking PrEP for Black women in the United States, and potential factors that could facilitate PrEP use. Both barriers and facilitators may be important targets for interventions to improve PrEP uptake. Future research focused on improving PrEP uptake among Black women in the United States should consider multi-level interventions that target barriers and facilitators to reduce rates of HIV infections.
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Affiliation(s)
- Kayla Pitchford
- The Virginia Consortium Program in Clinical Psychology, Old Dominion University, Norfolk, Virginia, USA
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Sylvia Shangani
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts, USA
- Social and Behavioral Sciences Department, Yale School of Public Health, New Haven, Connecticut, USA
| | - Charlotte Dawson
- The Virginia Consortium Program in Clinical Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Rainier Masa
- School of Social Work, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kristin Heron
- The Virginia Consortium Program in Clinical Psychology, Old Dominion University, Norfolk, Virginia, USA
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
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Nydegger LA, Kidane H, Benitez S, Yuan M, Claborn KR. A Qualitative Exploration of PrEP Interests, Barriers, and Interventions Among Black and Latina Cisgender Women in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:771-783. [PMID: 37796358 PMCID: PMC10844362 DOI: 10.1007/s10508-023-02712-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
Black and Latina cisgender women (BLCW) are disproportionally affected by HIV, particularly in the southern U.S. In Austin, Texas, Black women contract HIV 18.4 times more and Latinas 2.6 times more compared to White women. Pre-exposure prophylaxis (PrEP) is a medication that prevents contracting HIV; however, PrEP adoption among women is low. The current qualitative study aimed to explore PrEP awareness, interest, preferred PrEP administration methods, barriers to PrEP adoption, and future programs to increase PrEP adoption and adherence among BLCW. A total of 18 BLCW at high risk for HIV were enrolled. Participants completed 3 semi-structured interviews across 3 months. Interviews were transcribed verbatim, coded, and analyzed using thematic content analysis. Results demonstrated that BLCW had low PrEP awareness, high initial PrEP interest, and were interested in a long-acting injectable form of PrEP. Barriers to PrEP adoption included concerns regarding side effects, concerns about adherence to the currently available daily pill, and difficulty with insurance. Participants proposed different ideas for interventions, including support groups, education, community-level programs, and structural interventions. Future studies should focus on increasing PrEP awareness and HIV risk, consider alternative forms of PrEP, educate providers and medical staff on PrEP, and consider tailored interventions to reduce HIV risk among BLCW.
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Affiliation(s)
- Liesl A Nydegger
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Hampton House, 624 N. Broadway Street, Baltimore, MD, 21205, USA.
| | - Heran Kidane
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA
| | - Sabrina Benitez
- Department of Molecular Biosciences, University of Texas at Austin, Austin, TX, USA
| | - Mandy Yuan
- School of Human Ecology, University of Texas at Austin, Austin, TX, USA
| | - Kasey R Claborn
- School of Social Work, University of Texas at Austin, Austin, USA
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Irie WC, Croston MA, Mahone A. The Impact of Providers as Health Discussants on Black Women's Interest in PrEP for HIV Prevention. J Int Assoc Provid AIDS Care 2024; 23:23259582231225278. [PMID: 38173234 PMCID: PMC10768609 DOI: 10.1177/23259582231225278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
This study sought to examine the role of providers as health discussants (HD) on interest in preexposure prophylaxis for HIV prevention in a national sample of adult Black cisgender women (N = 315). Health discussant networks, a type of social network, may be influential in HIV prevention efforts. These networks, often composed of individuals' families, have improved health utilization outcomes in other disciplines. However, health discussants in HIV prevention are understudied, especially when considering providers as network members. We conducted a cross-sectional online survey and collected socio-demographic information, sexual history, HIV concerns, PrEP attitudes, healthcare utilization, mistrust, social support, and HD information. We used descriptive statistics and logistic regression to analyze data. Associations between PrEP interest and variables were examined. We found that older, partnered, who had recent healthcare visits or health insurance were more likely to involve healthcare providers as discussants. Anticipated PrEP stigma decreased provider involvement. Among participants listing providers as discussants, there was a greater likelihood of interest in using PrEP. Our findings indicate that healthcare provider support and social factors are crucial in promoting PrEP engagement among Black women. Integrating social dynamics and positive provider-patient interactions is essential for successful PrEP implementation.
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Affiliation(s)
- Whitney C. Irie
- Social Work, Boston College School of Social Work, Chestnut Hill, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Merriah A. Croston
- School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Anais Mahone
- School of Social Work, Rutgers, The State University of New Jersey,
New Brunswick, NJ, USA
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Pellowski JA, Price DM, Desir A, Golub S, Operario D, Purtle J. Using audience segmentation to identify implementation strategies to improve PrEP uptake among at-risk cisgender women: a mixed-methods study protocol. Implement Sci Commun 2023; 4:140. [PMID: 37978402 PMCID: PMC10656952 DOI: 10.1186/s43058-023-00518-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND In the USA, 19% of new HIV infections occur among cisgender women (cis women); however, only 10% of eligible cis women have been prescribed pre-exposure prophylaxis (PrEP) for the prevention of HIV infection (an evidence-based intervention). A fundamental challenge for expanding HIV prevention to cis women is ensuring implementation strategies are tailored to the various healthcare settings in which cis women seek care and the heterogeneous providers nested within these settings. This project's specific aims are to (1) explore clinician-level characteristics and organizational climate factors that are related to variability in adoption of PrEP service delivery as an evidence-based intervention for cis women; (2) identify latent audience segments of women's health providers as the related to PrEP acceptability, adoption, and maintenance and analyze demographic correlates of these segments; and (3) identify audience segment-specific implementation strategies to facilitate the adoption of PrEP as an evidence-based intervention among at-risk cis women. METHODS Using the i-PARIHS framework, this mixed-methods study examines three domains for guiding audience segmentation to facilitate PrEP implementation for cis women: innovation (degree of fit with existing practices, usability), recipient beliefs and knowledge and context factors (organizational culture, readiness for change), needs to determine appropriate facilitation methods. To achieve aim 1, qualitative interviews will be conducted with PrEP-eligible cis women, women's health providers, and other key stakeholders. Aim 2 will consist of a quantitative survey among 340 women's health providers. Latent class analysis will be used to facilitate audience segmentation. To achieve aim 3, a panel of 5-8 providers for each audience segment will meet and engage in iterative discussions guided by Fernandez's implementation mapping to identify (1) implementation outcomes and performance objectives, determinants, and change objectives and (2) determine and refine of implementation strategies for each audience segment. DISCUSSION This exploratory mixed methods study will provide an empirical foundation to inform the development implementations strategies aimed at increasing PrEP delivery to cis women among heterogenous groups of providers.
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Affiliation(s)
- Jennifer A Pellowski
- Department of Behavioral and Social Sciences, Brown University School of Public Health, International Health Institute, 121 South Main Street, Providence, RI, 02903, USA.
| | - Devon M Price
- Department of Psychology, Hunter College & Graduate Center of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
| | - Arielle Desir
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Sarit Golub
- Department of Psychology, Hunter College & Graduate Center of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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Krakower D, Marcus JL. Free the PrEP - Over-the-Counter Access to HIV Preexposure Prophylaxis. N Engl J Med 2023; 389:481-483. [PMID: 37548326 DOI: 10.1056/nejmp2305644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Affiliation(s)
- Douglas Krakower
- From the Division of Infectious Diseases, Beth Israel Deaconess Medical Center (D.K.), and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (D.K., J.L.M.) - both in Boston
| | - Julia L Marcus
- From the Division of Infectious Diseases, Beth Israel Deaconess Medical Center (D.K.), and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (D.K., J.L.M.) - both in Boston
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