Samantha A. Devlin

Use of patient portals is associated with improved engagement in care and health outcomes in a variety of healthcare contexts including among people with HIV (PWH). However, there are disparities in portal access and barriers to portal use including lack of awareness, need for more education, and mistrust or unfamiliarity with the technology used. We investigated whether a community health worker (CHW)-led pilot initiative could increase patient portal use among PWH. Participants who enrolled in the study received help with the patient portal (MyChart) and a one-time personalized 30-minute training session with the CHW on MyChart functions. Participants reported sociodemographic information, current MyChart use, barriers, and functions of interest. MyChart utilization data were retrieved for the six months before and after the training. Descriptive statistics were used to characterize the data, and McNemar’s exact tests were used to determine significant differences between pre-training and post-training intervals (a pre-post, single-arm study design). A total of 55 participants were enrolled and trained. The majority of participants were Black or African American (94.5%), and most had Medicaid or Medicare insurance (65.5%). The most frequently used MyChart functions included viewing lab results (65.5%) and health history (60.0%), scheduling appointments (56.4%), and sending messages (54.5%). The most commonly reported barriers were lack of time (21.8%) and not understanding how to use the portal (20.0%). There was a significant increase in read/view functions (reviewing test results, reading messages, etc.) after the training (61.8% to 81.8%, p-value = 0.048). The increase in use of write/update functions (responding to messages, paying bills, updating account information, etc.) was not statistically significant (56.4% to 72.7%, p-value = 0.216). The increase in use of some MyChart functions after the training indicates the potential of CHW-led interventions to address barriers and increase portal use among PWH.

Background: Black/African American cisgender women (hereafter referred to as “Black women”) experience one of the highest incidences of HIV yet are often not prioritized in HIV prevention initiatives. For example, pre-exposure prophylaxis (PrEP) for HIV prevention continues to be under-prescribed to women despite its proven effectiveness and demonstrated impact on mitigating HIV transmission. Increasing PrEP initiation and persistence among women through tailored implementation strategies remains crucial to HIV prevention efforts, yet few studies have been designed for women, particularly within the context of family planning centers. This article outlines the study protocol to evaluate the effectiveness of implementation strategies (“EUPHORIA”) to improve PrEP care continuum outcomes and to address barriers to PrEP uptake among women in family planning centers in Cook County, Illinois. Methods: This study builds upon previous work to adapt implementation strategies for increasing PrEP uptake among Black women. The intervention will consist of implementing a combination of strategies and measuring the impact on PrEP utilization among Black women at 8 family planning centers via a stepped-wedge cluster randomized trial. A mixed-methods approach will be utilized to evaluate implementation outcomes and assess the feasibility, acceptability, and effectiveness of the strategies. Discussion: As a result of the intervention, we anticipate that Black women within selected health centers will be more likely to receive PrEP prescriptions. During post-implementation analysis, we will identify key barriers and facilitators within the PrEP care continuum during the implementation process at the patient, provider, and system levels. This study contributes to addressing the inequity in PrEP delivery, aiming to increase initiation and persistence of PrEP for women in family planning centers. If determined effective, these implementation strategies will be further disseminated for use in similar family planning health centers and for future study in potential scale-up.

Despite representing a disproportionately high percentage of new HIV diagnoses in France annually, women who have migrated from Sub-Saharan Africa (WMSSA) remain underserved by HIV prevention strategies, including Pre-Exposure Prophylaxis (PrEP). This study aimed to understand healthcare providers’ experiences and attitudes toward PrEP delivery to WMSSA within family planning centers (FPCs) of the Paris region in France. We conducted a web-based cross-sectional survey from February to June 2024 to explore the knowledge, attitudes, and experiences of providers in FPCs in Paris and Seine-Saint-Denis (SSD) County. The survey link was emailed to FPC providers via their departmental mailing lists. Of the 284 providers who were contacted, 64 completed the survey (response rate of 23%). Respondents were predominantly women (95%), with a median age of 44 (IQR 35–53) and a median of 17.5 (IQR 10–26) years of professional experience. They worked as physicians (44%), midwives (34%), or nurses (22%), primarily in FPCs within SSD County (77%). All providers had heard of PrEP; 42% had already discussed it with a client; 28% reported PrEP prescriptions being offered in their FPC; and 21% had already prescribed it for a woman. Among participants, 42% had received PrEP training, and 53% rated their overall PrEP knowledge as good or very good. About one-third of providers reported feeling uncomfortable discussing or prescribing PrEP to women. The top three barriers to PrEP implementation were the lack of PrEP awareness among clients (32%), inadequate provider training (21%), and the limited number of PrEP prescribers in FPCs (21%). Providers endorsed multiple interventions to increase PrEP delivery, including PrEP training, educational materials, and policy shifts to broaden prescriber roles. FPC providers in Paris and SSD County have limited experience in delivering PrEP to women. Several facilitators were identified to inform PrEP implementation strategies at the provider, client and structural levels.

Background: Black cisgender women are disproportionately affected by HIV, yet have a low uptake of pre-exposure prophylaxis (PrEP). Barriers to HIV prevention exist on the individual, provider, and system level. This qualitative study aimed to explore factors associated with accessing culturally-appropriate PrEP educational materials and advertisements and receiving PrEP information from providers for Black women. Methods: Focus groups were conducted at three federally qualified health centers in Illinois, Florida, and North Carolina with Black female patients from August 2022 to February 2023. Women were asked about their awareness and knowledge of PrEP, thoughts on patient-facing PrEP materials, and ideas for improving PrEP uptake among Black women. Transcripts were analyzed thematically using the Stanford Lightning Report Method. Results: Twenty-five women participated across nine focus groups. Barriers and facilitators to patient education to increase PrEP uptake among Black women were identified across the individual, provider, and system level. Barriers included low awareness and knowledge of PrEP, inaccurate self-perceived risk of HIV, and stigma and medical mistrust. Facilitators included positive attitudes toward PrEP, better representation in educational materials and advertisements, improved provider-patient relationship, and additional support via mental wellness resources and community (social networks). Conclusions: Women reported minimal representation and knowledge regarding PrEP, yet demonstrated high interest in learning more about PrEP and sharing that information with others. Black women must be featured prominently in mainstream PrEP advertisements and PrEP educational materials and included by providers in discussions about PrEP. Increasing funding and support for these efforts will be instrumental to promote PrEP uptake among Black women and to reduce HIV transmission within this population.

Background: Preexposure prophylaxis (PrEP) is a medication that prevents HIV infection. However, PrEP is not equally used by all who would benefit. We examined PrEP disparities by comparing the number of sexually transmitted infections (STIs) and PrEP prescriptions across sex, race, and ethnic groups from 2 federally qualified health centers (FQHCs) in Pinellas County, Florida, and Chicago, Illinois. Methods: We obtained limited electronic medical record data from January 1, 2023, to December 31, 2023, and identified STI diagnoses (gonorrhea, chlamydia, or syphilis) and PrEP initiation prescriptions. We calculated the PrEP initiation rate for different sex, race, and ethnicity groups; the rate difference in PrEP initiations for each demographic group compared with that in White men; and the ratio of PrEP initiations to STI diagnoses in each group. Results: Out of a total of 63,591 patients, 1208 (1.9%) were diagnosed with an STI and 88 (0.1%) had PrEP initiation prescriptions. There was no rate difference per 100 people in PrEP initiation among Black and White men, but Hispanic men (−0.11), Black women (−0.14), White women (−0.24), and Hispanic women (−0.25) demonstrated PrEP disparities. When examining the ratio of PrEP initiations to STI diagnoses in each group, White men had (0.42) PrEP initiations per STI diagnosis, with much lower ratios seen for Hispanic men (0.2), Black men (0.13), Black women (0.04), White women (0.03), and Hispanic women (0.02). Conclusions: White men had the highest rate of initial PrEP prescriptions. Men overall received PrEP between 3 and 21 times more frequently per STI diagnosis than women.

Pre-exposure prophylaxis (PrEP) is an effective yet underutilized tool for HIV prevention. We examined opportunities for prescribing PrEP at two large, urban, academic healthcare institutions. We analyzed electronic medical record data for 1/1/2015-12/31/2021 among patients ≥ 18 years of age, with ≥ 1 negative HIV test with indications for PrEP. Eligible encounters were six months after a sexually transmitted infection, or when injection drug use (IDU) was documented. We categorized encounter setting, including the emergency department (ED) and obstetrics and gynecology/women’s health (OBGYN) department. We performed logistic mixed effects regression, reporting odds ratios and confidence intervals (OR, aOR, 95% CI). Overall, 9644 people contributed 53,031 encounters with 4653 PrEP prescriptions. The two institutions had different patient population demographics, with institution A having a higher proportion of women, patients aged 18–24, and non-Hispanic Blacks (NHB), and institution B having a higher proportion of men who have sex with men (MSM), non-Hispanic Whites (NHW), and Hispanic/Latinos. Adjusted models found lower odds of PrEP prescriptions for NHB (aOR 0.21 [0.15, 0.29]), Hispanic/Latino (aOR 0.53 [0.37, 0.76]), heterosexual women (aOR 0.10 [0.06, 0.17]), IDU (aOR 0.01 [0.001, 0.08]), and encounters at the ED or OBGYN (0.14 [0.06, 0.31]). Increased odds of PrEP prescription were seen among NHW (aOR 4.85 [3.45, 6.82]), MSM (aOR 24.87 [15.79, 39.15]), and patients at institution B (aOR 1.78 [1.25, 2.53]). Institution A contained people historically underrepresented in PrEP prescriptions, while institution B accounted for most PrEP prescriptions. Opportunities exist to improve equity in PrEP prescriptions among demographic groups and in hospital settings.

Pre-exposure prophylaxis (PrEP) for HIV remains largely underused among women who have migrated from sub-Saharan Africa (WMSSA), despite their accounting for a significant proportion of new HIV diagnoses in France and Western European countries. To expand PrEP reach, we explored healthcare providers’ perspectives on PrEP implementation within family planning centers (FPCs) in the Paris region through focus groups. The focus group discussion guide and rapid content analysis were informed by the Consolidated Framework for Implementation Research (CFIR) 2.0, which uses five domains to capture implementation determinants (Innovation, Outer Setting, Inner Setting, Individuals, and Implementation Process). Twenty providers participated across five focus groups and one key informant interview (median age 45; 80% women, 70% physicians). Oral PrEP was seen as easy to prescribe, but providers advocated for choices beyond the daily pill for better acceptability. While providers recognized increased HIV prevention needs among WMSSA, they found low PrEP demand among women stemming from a lack of knowledge. Although providers acknowledged that PrEP aligned with FPC missions, they cited significant implementation barriers, including limited resources, staff shortages, insufficient on-site capacity, competing priorities, and physicians being the sole prescribers. Provider-level implementation challenges included insufficient training and discomfort in discussing HIV risk and PrEP with WMSSA. Recommendations for implementing PrEP within FPCs included provider training and mentorship, tailored information campaigns for WMSSA, flexible delivery processes, support groups for women, and authorizing midwives and nurses to prescribe PrEP. These results support the need for tailored and multi-level implementation strategies to increase PrEP uptake among WMSSA attending FPCs in France.

Women who have migrated from sub-Saharan Africa (SSA) are underrepresented among HIV pre-exposure prophylaxis (PrEP) users in France (∼2%), yet they account for around 20% of new HIV infections annually. We conducted focus groups to explore the knowledge, attitudes, and perspectives of these women toward PrEP in a French family planning center (FPC). Focus groups occurred from November 2023 to February 2024 within the Lariboisière Hospital FPC in Paris. The social ecological model informed the discussion guide, which explored women’s PrEP experiences and determinants for uptake on various levels. Five focus groups were conducted ( N = 19). The median age of participants was 29 [interquartile range (IQR) 28–37]. Eight African countries were represented. The average time in France since migration was 3 (IQR 1–6) years. The majority of women had never heard of PrEP but expressed strong interest in learning more about it. Women underscored the difficulty of negotiating HIV prevention tools with their partners, risks from transactional sex, and barriers to PrEP use such as adherence challenges to daily pills and misconceptions about HIV transmission. There was strong interest in long-acting injectable PrEP. Women reported high trust in FPC providers and viewed the FPC as an ideal location to access PrEP. Conspiracy theories, cultural beliefs, and anticipated stigma were also identified as barriers to PrEP uptake. Most women advocated for disseminating PrEP information to their peers using diverse community outreach strategies. Despite a strong interest, increasing PrEP uptake in women from SSA will remain challenging without multi-faceted and adapted implementation strategies.

Background: Black cisgender women (hereafter referred to as “women”) experience one of the highest incidences of HIV among all populations in the United States. Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, but uptake among women is low. Despite tailored strategies for certain populations, including men who have sex with men and transgender women, Black women are frequently overlooked in HIV prevention efforts. Strategies to increase PrEP awareness and use among Black women are needed at multiple levels (ie, community, system or clinic, provider, and individual or patient). Objective: This study aimed to identify barriers and facilitators to PrEP uptake and persistence among Black cisgender women and to map implementation strategies to identified barriers using the CFIR (Consolidated Framework for Implementation Research)-ERIC (Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool. Methods: We conducted a secondary analysis of previous qualitative studies completed by a multidisciplinary team of HIV physicians, implementation scientists, and epidemiologists. Studies involved focus groups and interviews with medical providers and women at a federally qualified health center in Chicago, Illinois. Implementation science frameworks such as the CFIR were used to investigate determinants of PrEP use among Black women. In this secondary analysis, data from 45 total transcripts were analyzed. We identified barriers and facilitators to PrEP uptake and persistence among cisgender women across each CFIR domain. The CFIR-ERIC Implementation Strategy Matching Tool was used to map appropriate implementation strategies to address barriers and increase PrEP uptake among Black women. Results: Barriers to PrEP uptake were identified across the CFIR domains. Barriers included being unaware that PrEP was available (characteristics of individuals), worrying about side effects and impacts on fertility and pregnancy (intervention characteristics), and being unsure about how to pay for PrEP (outer setting). Providers identified lack of training (characteristics of individuals), need for additional clinical support for PrEP protocols (inner setting), and need for practicing discussions about PrEP with women (intervention characteristics). ERIC mapping resulted in 5 distinct implementation strategies to address barriers and improve PrEP uptake: patient education, provider training, PrEP navigation, clinical champions, and electronic medical record optimization. Conclusions: Evidence-based implementation strategies that address individual, provider, and clinic factors are needed to engage women in the PrEP care continuum. Tailoring implementation strategies to address identified barriers increases the probability of successfully improving PrEP uptake. Our results provide an overview of a comprehensive, multilevel implementation strategy (ie, “POWER Up”) to improve PrEP uptake among women. International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0285858