Significant disparities in pre-exposure prophylaxis (PrEP) for HIV prevention exist in the U.S. with cisgender
women making up a disproportionately low percentage of PrEP users compared to men. 60% of new HIV
diagnoses among women are among Black women, the majority of whom reside in the South. Challenges exist
at each step of the PrEP care continuum, including difficulty identifying cisgender women at highest risk for HIV
who are most likely to benefit from PrEP, low self-perception of HIV risk, low levels of PrEP knowledge, and
barriers to PrEP initiation and persistence. While there has been growing knowledge of interventions to
increase PrEP use among men who have sex with men and transgender women, much less is known about
successful strategies to increase uptake and support PrEP persistence among Black cisgender women.
Through preliminary work, our team has identified a set of successful strategies for PrEP Optimization among
Women to Enhance Retention and Uptake (POWER Up) in community health center (CHC) settings,
consisting of routine PrEP education for Black cisgender women, standardized provider training, electronic
medical record tools for identifying women who would benefit from PrEP and tracking PrEP outcomes, and
PrEP navigation. With These POWER Up strategies, a CHC network in the Midwest has more than doubled
PrEP uptake among Black cisgender women and maintained PrEP persistence rates above the national
average. These strategies have not been studied in CHCs with a large population of Black cisgender women
outside of the Midwest. Therefore, we propose to refine, implement, and evaluate the impact of a CHC-focused
intervention to improve PrEP care continuum outcomes for Black cisgender women in the Southern US, using
implementation science research methods.
Guided by the Exploration, Preparation, Implementation and Sustainment (EPIS) implementation science
framework, we will undertake the following aims: 1) Preparation: Adapt previously identified successful
implementation strategies for engaging Black cisgender women in the PrEP care continuum in a Midwestern
CHC for use in Southern CHCs. 2) Implementation: Via a hybrid type II design using the RE-AIM framework,
measure the implementation and effectiveness outcomes of the adapted interventions in the Southern United
States compared to the approach in the Midwest. We will complete a stepped wedge randomized controlled
trial in 16 CHCs in the Midwest and South. 3) Sustainment and Spread: Develop an implementation guide
that can be utilized across Southern U.S. jurisdictions to improve PrEP care continuum engagement among
Black cisgender women reflecting the knowledge gained through adaptation. This will allow for rapid
dissemination and replication of these strategies to improve PrEP care continuum outcomes among Black
cisgender women.
