HIV Pre-exposure Prophylaxis Use and Persistence among Black Ciswomen: “Women Need to Protect Themselves, Period”

Abstract

Background Disparities in HIV incidence and PrEP use among Black ciswomen remain. We examine factors associated with PrEP persistence using mixed methods. Setting Black ciswomen in Chicago, IL, prescribed PrEP at a federally qualified health center (FQHC). Methods We used electronic health data to determine PrEP persistence (Proportion of Days Covered ≥86% at 6 months) and tested demographic and clinical factors in logistic regressions. We interviewed eight Black ciswomen, purposefully selected by PrEP persistence. Results Among 112 Black ciswomen, 18% were persistent. In adjusted models, neighborhood, visit reason (at initiation), and initiation year were significantly associated with persistence. Qualitatively, we found little evidence of cost or adherence as barriers; participants reported low community awareness, importance of providers, and concerns around stigma, side effects, and pregnancy while using PrEP. Conclusion While persistence among Black ciswomen was low, patients were often making decisions based on perceived HIV risk. We identified real-world barriers to address in future interventions.

US Black cisgender women and pre-exposure prophylaxis for human immunodeficiency virus prevention: A scoping review

“… 72 Another study found that after 6 months, only 18% ( n = 18) of younger women continued taking PrEP for the duration of a 6-month study. 74 Reported barriers to adherence included forgetting or not being near pill boxes, uncertainty about risk, and concerns about access and medication efficacy. 69 , 74 A study designed to address barriers utilized a 48-week text messaging intervention that incorporated significant support from study coordinators.…”

“… 74 Reported barriers to adherence included forgetting or not being near pill boxes, uncertainty about risk, and concerns about access and medication efficacy. 69 , 74 A study designed to address barriers utilized a 48-week text messaging intervention that incorporated significant support from study coordinators. 70 At week 48, 62% of participants ( n = 121) were retained in the study while 18% were able to adhere to a six-dose per week regimen of PrEP.…”

Long-term HIV Pre-exposure Prophylaxis Trajectories Among Racial & Ethnic Minority Patients: Short, Declining, & Sustained Adherence

“…[31][32][33][34] Cismen were more likely to be in the sustained PrEP use trajectory, and bisexual and straight patients in the short PrEP use group, which suggests PrEP awareness and acceptability differ by gender identity and sexual orientation. [35][36][37][38][39][40] Together, this suggests reducing structural barriers such as insurance and access to health care, and addressing PrEP and HIV stigma in some communities, may help improve PrEP adherence. [41][42][43][44][45] However, our results also show that among those in the short PrEP use trajectory, access to health insurance alone may not be sufficient.…”

Control groups for HIV prevention efficacy trials: what does the future hold?

“…For example, will the most appropriate comparator be CAB-LA, or will it be acceptable to use TDF-FTC? It will be difficult to demonstrate superiority over CAB-LA, as clinic administration minimizes the adherence challenges that appear to influence oral PrEP efficacy [27][28][29][30]. Its high cost has restricted CAB-LA adoption as standard of care [31,32], thus providing it as part of a clinical trial raises questions around poststudy access.…”