Barriers and Facilitators to Integrating PrEP into Women’s Health Clinical Services in the United States (US)
Abstract Authors
Kandis V. Backus, Elise Healy, Emma Murphy, Arianna R. Means, Erykah Pasha, Rebecca Lumpkin, Tiffany D. Lloyd, Bethany Spier, Cathy J. Berry, Christine M. Khosropour
Author Affiliations
Gilead Sciences (Kandis V. Backus) University of Washington (Elise Healy, Emma Murphy, Arianna R. Means, Christine Khosropour) Layla's Got You / Allyn Family Foundation (Erykah Pasha, Rebecca Lumpkin, Tiffany D. Lloyd) Cathy J. Berry and Associates (Bethany Spier, Cathy J. Berry)
Background
PrEP has not been routinely integrated into women’s health clinical services in the US, likely contributing to suboptimal PrEP uptake. We investigated barriers and facilitators to integrating PrEP into women’s health clinical services from the perspective of patients and clinical staff in a midsize city in the northeast US.
Methods
In April 2023 we conducted two focus group discussions (FGDs) with 22 cisgender women of color. Discussions focused on patient awareness/knowledge of PrEP, experiences accessing sexual healthcare, and preferences in services offered by PrEP providers. In May-June 2023 we conducted one-on-one in-depth interviews (IDI) with 11 clinical staff (medical assistants, nurses, physicians/midwives) in an Obstetrics/Gynecology private practice. Interviews focused on staff awareness/knowledge of PrEP, desire to offer PrEP, and barriers/facilitators to integrating PrEP into clinic flow. Thematic analysis, informed by the COM-B and Theoretical Domains Framework, was used to identify determinants of integration.
Results
The median age of FGD participants was 20 years and 91% identified as Black. Key themes included: low awareness of and misconceptions about PrEP (e.g., PrEP is for gay men); perceived stigma about PrEP (e.g., PrEP implies multiple sexual partnerships); previous negative experiences seeking medical care (e.g., feeling judged); desire for clinics to promote PrEP as a self-care tool and integrate it with holistic reproductive healthcare. Women noted perceived barriers related to cost/insurance and accessibility but also a willingness and desire to incorporate PrEP into daily routines. Most IDI participants worked in the practice for >3 years. Similar to patient-level themes, clinical staff had low awareness of and misconceptions about PrEP. Barriers to integrating PrEP included: lack of PrEP knowledge, lack of time to integrate PrEP services within routine visits, challenges with billing insurance for integrated services, and heterogeneity in comfort with sexual health discussions with patients. Facilitators included staff buy-in to provide PrEP and willingness to adapt clinical protocols to integrate PrEP, rooted in recognition that HIV prevention is important for their patients and community.
Conclusion(s)
Similar misconceptions about PrEP exist among cisgender women in the community and clinical providers working in women’s health. Directly addressing shared and distinct patient and provider-level concerns may facilitate integration of services.