Using Audience Segmentation to Identify Implementation Strategies to Improve PrEP Uptake Among At-Risk Cisgender Women - PROJECT ABSTRACT
In the US, 18% of new HIV infections occur among cisgender women (cis-women), with these rates reaching as
high as 30% in some parts of the U.S., however, only 7% of eligible cis-women have been prescribed pre-
exposure prophylaxis (PrEP) for the prevention of HIV infection. Notably, areas with higher HIV incidence among
cis women also have the lowest rates of PrEP uptake among this group. Unlike men who have sex with men or
trans-women, cis-women are more likely to seek PrEP from a variety of clinical settings including ones that focus
more on sexual and reproductive health and family planning, such as OB/GYN healthcare practices in addition
to LGBT oriented services. There is a crucial need to develop the science of PrEP implementation in the context
of sexual and reproductive health services for cis-women. Promising implementation strategies to improve PrEP
delivery for women include targeting organizational/clinic factors, provider acceptability of PrEP as an HIV
prevention strategy for cis-women, providers’ perceived scope of practice, and cis-women’s knowledge about
specific considerations for PrEP. Audience segmentation is a novel approach that can assist in understanding
this variability in implementation strategies, categorize sexual health providers based on their needs and
organizational climates (audience segments), and to match these sub-populations to appropriate implementation
strategies to increase the prescription of PrEP in order to curb HIV infection rates among at-risk cis-women.
Utilizing a sequential mixed methods design and guided by the i-PARIHS framework, this study aims to develop
implementation strategies that match the heterogenous needs of clinical providers in variable sexual health
settings for increasing the uptake of PrEP among cis-women. Aim 1 will use qualitative methods (in-depth
interviews sexual health providers working with cis-gender women who have prescriptive authority, PrEP eligible
cis-women [cis-women on, and not currently on PrEP], and administrative stakeholders) to identify potential
clinician characteristics and clinical environmental factors related to audience segments of sexual health
providers. Qualitative findings will inform survey content to be used in Aim 2. Aim 2 includes quantitative surveys
with ~340 sexual health providers, analyzed using latent class analysis to identify key audience segments based
on providers’ patterns of responses, creating groups of individuals that have similar attitudes, needs, and
organizational climates. Utilizing expert provider panels, Aim 3 seeks to match the audience segments to menus
of implementation strategies suitable for the specific needs and organizational climates of these audience
segments. The proposed study has the potential to make a significant contribution to our understanding of
appropriate implementation strategies for the variable sexual health settings in which cis-women seek PrEP and
the results of this study will provide innovative approaches for future applications focused on clinicians within
healthcare settings designed to improve the implementation of PrEP for at-risk cis-women, a key population for
effective HIV prevention strategies.
