Optimizing Delivery of HIV Preexposure Prophylaxis for Women in the United States

Abstract

Preexposure prophylaxis (PrEP) is a highly effective HIV prevention method; however, it is underutilized among women who are at risk for acquisition of HIV. Women comprise one in five HIV diagnoses in the United States, and significant racial disparities in new HIV diagnoses persist. The rate of new HIV diagnoses among black and African American women in 2015 was 16 times greater than that of white women. These disparities highlight the importance of HIV prevention strategies for women, including the use of PrEP. PrEP is the first highly effective HIV prevention method available to women that is entirely within their control. However, because so few women who may benefit from PrEP are aware of it, few women's healthcare providers offer PrEP to their patients, PrEP has not yet achieved its potential to reduce HIV infections in women. This article describes individual and systemic barriers for women related to the uptake of PrEP services; explains how providers can identify women at risk for HIV; reviews how to provide PrEP to women; and outlines client-centered models for HIV prevention services. Better access to culturally acceptable and affordable medical and social services may offer support to women for consistent and ongoing use of PrEP. This discussion may be used to inform HIV prevention activities for women and guide interventions to decrease racial/ethnic disparities in rates of HIV infection among US women.

The Impact of Delivery in a Rural County on a Cohort of Women Living with HIV Infection and Their Infants

“…Confirmed perinatal HIV transmission occurred in 1.2% of HIV‐exposed infants during the study period, which is consistent with national estimates . All perinatally infected infants born in South Carolina from 2004 to 2014 delivered in urban counties.…”

“…Confirmed perinatal HIV transmission occurred in 1.2% of HIV-exposed infants during the study period, which is consistent with national estimates. 16 All perinatally infected infants born in South Carolina from 2004 to 2014 delivered in urban counties. Based on previously published data, we had anticipated that approximately a quarter of women living with HIV in South Carolina would reside and potentially deliver in a rural county.…”

Acceptability of a long‐acting injectable HIV prevention product among US and African women: findings from a phase 2 clinical Trial (HPTN 076)

“…Women’s challenges adhering to daily oral and vaginal PrEP within earlier clinical trials , and their relatively slow uptake of oral PrEP in service delivery settings underscore the need for alternative PrEP delivery modes. As new HIV prevention approaches move through clinical trial research, it is important to assess what features of these products are acceptable – even desirable, and for whom .…”

“…We conducted separate principal component analyses (PCA) with varimax rotation on the set of seven items describing motivations for trial participation and the eight items describing acceptability of “injectable attributes” and “physical experiences.” The PCA of trial motivations showed two distinct PCs where the first PC comprised three items denoting “altruism” and the second PC comprised four items describing “personal and health benefits.” Similarly, two distinct PCs were found in the PCA of acceptability where the first PC comprised five product acceptability items denoted as “injectable attributes” and the second PC comprised three items denoted as “physical experiences.” The scores for each of the four PCs were calculated as weighted sums of measures of their components with weights , where w i s were the loadings from the principal component analysis. The ranges of scores were the same as the ranges of the measures of components .…”

“…The scores for each of the four PCs were calculated as weighted sums of measures of their components with weights W i = P W , where w i s were the loadings from the principal component analysis. The ranges of scores were the same as the ranges of the measures of components [1][2][3][4][5][6].…”