JMIR Publications

ABSTRACT

Background:

Black cisgender women (hereafter referred to as “women”) experience one of the highest incidences of HIV among all populations in the United States. Effective biomedical HIV prevention options such as pre-exposure prophylaxis (PrEP) exist, but uptake among women remains low. Strategies to increase PrEP awareness and use among Black women are needed at multiple levels (i.e., community, system/clinic, provider, and individual/client).

Objective:

To identify barriers and facilitators to PrEP uptake and persistence among cisgender women at a federally qualified health center and to map implementation strategies to identified barriers using the CFIR (Consolidated Framework for Implementation Research)-ERIC (Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool.

Methods:

Qualitative interviews were conducted with patients who identified as Black women and with medical providers in the Midwest. Content analysis was used to identify barriers and facilitators of PrEP uptake, and the CFIR-ERIC Implementation Strategy Matching Tool was used to map appropriate implementation strategies to address barriers and increase PrEP uptake among Black women.

Results:

Barriers to PrEP uptake were identified across the CFIR domains by patients. Barriers included being unaware that PrEP was available (characteristics of individuals), worrying about side effects and impacts on fertility/pregnancy (intervention characteristics), and being unsure about how to pay for PrEP (outer setting). Providers identified lack of training (characteristics of individuals), need for additional clinical support for PrEP protocols (inner setting), and need for practicing discussions about PrEP with women (intervention characteristics). ERIC mapping resulted in five distinct implementation strategies to address barriers and improve PrEP uptake: patient education, provider training, PrEP navigation, clinical champions, and electronic medical record (EMR) optimization.

Conclusions:

Tailoring implementation strategies to address identified barriers increases the probability of successfully improving PrEP uptake. Results provide an overview of a comprehensive, multi-level implementation strategy (i.e., “POWER Up”) to improve PrEP uptake among women.