JMIR Publications

ABSTRACT

Background:

HIV pre-exposure prophylaxis (PrEP) is an effective strategy to reduce the risk for acquiring HIV up to 99%. However, HIV incidence among Black cisgender women in the southern United States remains high. Behavioral interventions to improve PrEP uptake often focus on men that have sex with men. Examining the degree to which Black cisgender women have engaged in PrEP interventional studies, and the effectiveness of the existing PrEP interventions will inform HIV prevention strategies tailored for Black cisgender women.

Objective:

The purpose of this review is to assess and synthesize the current literature related to behavioral interventions that address uptake of PrEP as a strategy to reduce HIV incidence among Black cisgender women living in the southern US. We will also identify potential implement strategies to improve the engagement of Black cisgender women in the HIV-PrEP continuum.

Methods:

An expert librarian used Covidence software to screen behavioral interventions that included the uptake of PrEP as an outcome to reduce HIV incidence among Black cisgender women in the southern US. An expert librarian conducted a comprehensive search of peer-reviewed articles using APA PsycInfo, CINAHL Complete, Cochrane Library, PubMed, Sociological Abstracts and Web of Science. Search terms included: Black, woman, PrEP, and intervention. The initial search identified 738 relevant study titles. After deduplication and the screening process, 26 peer-reviewed, full-text articles were retrieved, among which five met our inclusion criteria, and were included in the final analysis guided by the social-ecological framework.

Results:

APA PsycInfo (n=85), CINAHL Complete (n=181), Cochrane Library (n=43), PubMed (n=214), Sociological Abstracts (n=7) and Web of Science (n=208). Two of the articles targeted the individual level, while one article was cited for each of the interpersonal, organizational, and community levels; no articles were targeted for the policy/societal level. Though there was inconsistency in measures of uptake of PrEP across the studies, tailored case management, same-day PrEP modalities, and the emphasis on motivational interviewing were determined to be the most effective strategies for promoting uptake of PrEP among Black women. Studies with a focus on case management had the greatest impact on PrEP uptake among Black women with more than two-thirds of the women in the same-day PrEP intervention filling PrEP prescriptions and one-third of the women taking PrEP by the second session in the MI-PrEP intervention.

Conclusions:

The findings from this review imply that increased funding, low-barrier access to PrEP prescriptions, and developing interventions that address social determinants of health may improve Black women’s access to PrEP. This review provides a cross-sectional outlook of the limited quantity and heterogeneity in interventions and measures currently employed to assess the uptake of PrEP among Black women.