Considerations for the Design of Pre-exposure Prophylaxis (PrEP) Interventions for Women: Lessons Learned from the Implementation of a Novel PrEP Intervention

Walters, Suzan M.; Platt, Joey; Anakaraonye, Amarachi R.; Golub, Sarit A.; Cunningham, Chinazo O.; Norton, Brianna L.; Sevelius, Jae; Blackstock, Oni J.

doi:10.1007/s10461-021-03353-2

Cited by 26 publications

(21 citation statements)

References 84 publications

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“…Yet, once aware and knowledgeable about PrEP, PWID are interested in taking it [ 5 , 107 ]. Similar to other studies, participants in this study described perceived low HIV risk as a reason for not being interested in taking PrEP [ 108 ]. Although participants may have accurately described their risk, past research has shown that perceived HIV risk does not always match actual risk [ 34 ] and a recent study found that 92% of PWID sampled in Massachusetts met CDC indications for PrEP [ 109 ].…”

Section: Discussionsupporting

confidence: 77%

PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure

et al. 2021

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Pre-exposure prophylaxis (PrEP) is a medication that prevents HIV acquisition, yet PrEP uptake has been low among people who inject drugs. Stigma has been identified as a fundamental driver of population health and may be a significant barrier to PrEP care engagement among PWID. However, there has been limited research on how stigma operates in rural and urban settings in relation to PrEP. Using in-depth semi-structured qualitative interviews (n = 57) we explore PrEP continuum engagement among people actively injecting drugs in rural and urban settings. Urban participants had more awareness and knowledge. Willingness to use PrEP was similar in both settings. However, no participant was currently using PrEP. Stigmas against drug use, HIV, and sexualities were identified as barriers to PrEP uptake, particularly in the rural setting. Syringe service programs in the urban setting were highlighted as a welcoming space where PWID could socialize and therefore mitigate stigma and foster information sharing.

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Section: Discussionsupporting

confidence: 77%

PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure

et al. 2021

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“…As a result, the authors recommended embedding PrEP in the latter, alongside peer- and structurally competent interventions. 18 …”

Section: Discussionmentioning

confidence: 99%

“… 6 , 17 In the United Kingdom, gay and bisexual men considered peer support from friends and partners who used PrEP essential, ‘ less abstract ’ and ‘ more trustworthy ’ than general information about PrEP. 17 In the United States, qualitative assessment of a PrEP intervention for cis and trans women found its ‘ women-focused approach ’ and ‘ peer outreach and navigation ’ to be key factors facilitating uptake 18 (pp. 3987).…”

Section: Introductionmentioning

confidence: 99%

‘We go where we know’: Reflections from Mobilizing for PrEP and Sexual Health (MobPrESH) – A peer-led PrEP education programme across England, for and by women and non-binary people

Grenfell

Rafael

Calliste³

et al. 2022

Womens Health (Lond Engl)

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Background: Pre-exposure prophylaxis is a highly effective method of HIV prevention but few women know about it, have access to it, or see it as relevant to them. In 2019, grassroots organization PrEPster piloted a peer-led intervention, MobPrESH (Mobilizing for Pre-Exposure prophylaxis (PrEP) and Sexual Health), across three sites in England, to mobilize for PrEP and sexual health with communities of women and non-binary people most affected by HIV, including Black women and non-binary people, people of colour, migrants, and transgender (trans) women. Objectives: We aimed to explore the accessibility, feasibility, acceptability, and ‘fidelity’ of MobPrESH, from the perspectives of peer mobilizers and project staff. Methods: We conducted focus group discussions and qualitative interviews with nine peer mobilizers (most identified as Black cisgender (cis) women) and six project staff (including Black and white cis women and non-binary people). We analysed data thematically, iteratively, and inductively, informed by concepts of reproductive and social justice. Results: We present findings in five thematic areas: connecting and relating to situate sexual health discussions, navigating silence and stigma, connecting within and across communities, competing pressures and structural hostilities, and resources and continuity. Community knowledge-building about PrEP is a slow, iterative process that needs investment and creation of trusted spaces that centre communities’ needs and concerns. Peer mobilizers and the communities they engaged with had competing demands in their lives, and knowledge-raising about PrEP was impacted by intersecting stigmas, discrimination, and oppressions around HIV status, racism, misogyny, transphobia, homophobia, and anti-sex worker rhetoric. Conclusions: Peer-led PrEP interventions require funding and foregrounding, particularly for women and non-binary people who are Black, trans, migrants, and people of colour, situated relative to their wider health needs, life pressures, and priorities. This requires concurrent challenge of the racist and patriarchal structures that continue to obscure the sexual and reproductive health needs of racially minoritized and marginalized women and non-binary people.

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“…Such studies would categorize by gender rather than sex assigned at birth and would better represent gendered dynamics of individuals’ social ecologies that shape their health behaviors and experiences. Examples of such research can be found in some implementation strategies and interventions trials, including Walters et al’s ( 2021 ) implementation of a PrEP intervention for cisgender and transgender women and Auerbach et al’s ( 2021 ) interviews with cisgender and transgender women on developing HIV care for all women. It must be noted, though, that limited sub-samples of transgender individuals within samples lumping cisgender MSM and transgender women is not unique to implementation science.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Pre-exposure Prophylaxis (PrEP) Implementation in Transgender Populations: A Qualitative Scoping Review

Zamantakis

Benbow

et al. 2022

AIDS Behav

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We conducted a scoping review of contextual factors impeding uptake and adherence to pre-exposure prophylaxis in transgender communities as an in-depth analysis of the transgender population within a previously published systematic review. Using a machine learning screening process, title and abstract screening, and full-text review, the initial systematic review identified 353 articles for analysis. These articles were peer-reviewed, implementation-related studies of PrEP in the U.S. published after 2000. Twenty-two articles were identified in this search as transgender related. An additional eleven articles were identified through citations of these twenty-two articles, resulting in thirty-three articles in the current analysis. These thirty-three articles were qualitatively coded in NVivo using adapted constructs from the Consolidated Framework for Implementation Research as individual codes. Codes were thematically assessed. We point to barriers of implementing PrEP, including lack of intentional dissemination efforts and patience assistance, structural factors, including sex work, racism, and access to gender affirming health care, and lack of provider training. Finally, over 60% of articles lumped cisgender men who have sex with men with trans women. Such articles included sub-samples of transgender individuals that were not representative. We point to areas of growth for the field in this regard.

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Considerations for the Design of Pre-exposure Prophylaxis (PrEP) Interventions for Women: Lessons Learned from the Implementation of a Novel PrEP Intervention

Cited by 26 publications

References 84 publications

PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure

PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure

‘We go where we know’: Reflections from Mobilizing for PrEP and Sexual Health (MobPrESH) – A peer-led PrEP education programme across England, for and by women and non-binary people

Determinants of Pre-exposure Prophylaxis (PrEP) Implementation in Transgender Populations: A Qualitative Scoping Review

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