Using PrEP and Doing it for Ourselves (UPDOs Protective Styles), a Web-Based Salon Intervention to Improve Uptake of Pre-exposure Prophylaxis Among Black Women: Protocol for a Pilot Feasibility Study

A Qualitative Study Exploring How the Perspectives and Experiences of Cisgender Black Women Inform Their Readiness to Consider Pre-Exposure Prophylaxis for HIV Prevention

Attention to increasing pre-exposure prophylaxis (PrEP) use among cisgender Black women (CBW) in the southern United States (U.S.) is necessary to achieve national 2030 Ending the HIV Epidemic (EHE) goals. Qualitative exploration of CBW's readiness to use PrEP is necessary to discern whether practical solutions to addressing PrEP uptake within this HIV-vulnerable population are feasible. Focus group discussions (n = 5) and key informant interviews (n = 3) in two EHE jurisdictions in Houston and Austin, Texas were used to explore how perspectives and lived experiences may serve as facilitators and/or barriers to PrEP readiness among 20 CBW. Codes highlighted facilitators and barriers to PrEP readiness. Facilitators involved positive experiences with the healthcare system, high perceived HIV vulnerability, and prioritizing PrEP as self-care. Barriers encompassed concerns with sexual relationship dynamics, mental health implications, and access to humane treatment within the healthcare system. High perceived vulnerability of HIV acquisition is related to an awareness that CBW may not know the entirety of their partner's sexual activities. Findings indicate precursors of PrEP readiness and challenge the notion that CBW have low perceived vulnerability of acquiring HIV.

PrEP knowledge and perceptions among women living in North Carolina public housing communities

Women in low-income communities are disproportionately affected by HIV yet have been largely left out of efforts to raise awareness about pre-exposure prophylaxis (PrEP). To inform future awareness campaigns, we assessed women's current knowledge of and attitudes toward PrEP. We surveyed 184 women living in public housing communities in North Carolina regarding PrEP knowledge, attitudes, and perceived norms, as well as reported HIV-associated factors and perceived HIV acquisition chances. 38 women participated in eight focus group discussions (FGDs) addressing personal and community PrEP perceptions. Survey participants were 46 years old on average, and 86% identified as Black/African American. Only 35% had heard of PrEP, yet, after being told what it was, 61% said they probably or definitely would take PrEP in the next 6 months. Most women believed that if they decided to take PrEP, their partner (72%) or their family (66%) would approve. When asked about the importance of factors influencing their interest in PrEP, women most frequently rated possible side effects as important or very important (76%), followed by cost considerations (67% for cost of PrEP, 74% for cost of clinic visits and labs). In the FGDs, women had limited PrEP knowledge, but several had heard of PrEP from television commercials, which gave them the impression that PrEP was only for men. Women were concerned about potential side effects, interactions with other medications, safety during pregnancy, and the burden of daily dosing. Most FGD participants expressed generally positive attitudes toward PrEP, but some thought other women would be uninterested due to low perceived chances of HIV acquisition. Overall, these results suggest that while few women had previously heard of PrEP, most were interested in PrEP after receiving information about it and perceived positive community attitudes toward PrEP. Our findings indicate the importance of community-based PrEP communication that speaks to cisgender women, provides information on side effects, and offers destigmatized messaging regarding reasons for HIV prevention for women to consider.

Identifying CFIR Inner Setting Factors in the Implementation of a Salon-Based Intervention to Reduce Barriers and Improve Pre-Exposure Prophylaxis (PrEP) Uptake Among Black Women in US South

US Black women are disproportionally represented in new HIV diagnoses. PrEP is effective in HIV prevention, but Black women's uptake is low. The UPDOs salon-based intervention is effective in overcoming barriers to care but scaling implementation is needed. This mixed-method pilot study sought to understand how salon organizational factors may have influenced UPDOs implementation with a focus on organizational culture, team culture, relational connection, and communication within a Consolidated Framework for Implementation Research (CFIR) inner setting lens. Organizational culture and team culture were measured using the Organizational Culture Survey (OCS) and Team Psychological Safety Scale (TPS). Relational connection and communication were explored qualitatively using participant observations and semi-structured interviews. Findings were positive towards teamwork, morale, information flow, involvement, and supervision as well as reflected positive organizational environment that were supportive of developing knowledge and skills. Relational connection and communication created a trusting environment that facilitated implementation. Future research can benefit from examining organizational environment when scaling interventions to overcome HIV and PrEP inequities.

Using an Equity in Research Framework to Develop a Community-Engaged Intervention to Improve Preexposure Uptake Among Black Women Living in the United States South

ABSTRACT

In the U.S. South, over half of new HIV diagnoses occur among Black Americans with research lagging for women who face increased HIV rates and low PrEP uptake, among other health inequities. Community engaged research is a promising method for reversing these trends with established best practices for building infrastructure, implementing research, and translating evidence-based interventions into clinical and community settings. Using the 5Ws of Racial Equity in Research Framework (5Ws) as a racial equity lens, the following paper models a review of a salon-based intervention to improve PrEP awareness and uptake among Black women that was co-developed with beauty salons, stylists, and Black women through an established community advisory council. In this paper we demonstrate how the 5Ws framework was applied to review processes, practices, and outcomes from a community-engaged research approach. The benefits of and challenges to successful collaboration are discussed with insights for future research and community impact.

Digital Interventions to Enhance PrEP Uptake and Adherence Through Stigma Reduction

PURPOSE OF REVIEW

Although pre-exposure prophylaxis (PrEP) is effective for reducing risk of HIV transmission, stigma persists as a barrier to HIV prevention. Digital technologies present opportunities to access hard-to-reach populations and increase the efficiency of established interventions. This review examines current digital interventions addressing stigma to improve PrEP-related outcomes.

RECENT FINDINGS

Digital technologies are increasingly used for HIV prevention and include a wide range of formats. Recent interventions focused on stigma and PrEP tend to engage mobile phone-related technology and focus on younger populations with particular attention to men who have sex with men and transgender women. Digital interventions that address stigma are promising for improving PrEP-related outcomes. No single technology currently demonstrates consistent superiority. Limited access to PrEP and heightened stigma in under-resourced countries present challenges for interventions supporting diverse communities. Further research should examine how digital interventions can reduce stigma beyond the individual level to enhance PrEP use and explore opportunities to improve and integrate approaches to stigma measurement.

UPDOs Protective Styles, a Multilevel Intervention to Improve Pre-exposure Prophylaxis Uptake Among Black Cisgender Women: Pretest-Posttest Evaluation

ABSTRACT

In the United States, Black cisgender women account for one in five new HIV infections with Black Americans, accounting for 57% of new diagnoses in the South. Pre-exposure prophylaxis (PrEP) is 99% effective at preventing HIV. Still, Black women's uptake remains at 2% due to multiple documented barriers, including lack of awareness and knowledge, mistrust, stigma, and low perceived risk. Culturally relevant interventions leveraging trusted venues, such as beauty salons, can overcome these barriers. This article reports preliminary results of an intervention to improve PrEP knowledge and awareness, PrEP stigma, PrEP trust, and uptake among Black cisgender women. This multilevel, mixed-methods study used a community-engagement approach to develop and pilot a salon-based intervention, Using PrEP and Doing it for Ourselves (UPDOs) Protective Styles. The intervention improved knowledge, awareness, and trust around PrEP among Black cisgender women. PrEP use stigma within interpersonal relationships decreased, but low perceived risk and social stigma remained constant. Culturally and socially acceptable interventions like UPDOs Protective Styles can model health care delivery to improve trust, thus improving uptake over time for this population.