Implementation strategies to support pre-exposure prophylaxis for HIV prevention care for cisgender women in federally-funded family planning clinics in Atlanta, Georgia.

Abstract

Introduction: Title X-funded family planning clinics stand to play a significant role in Ending the HIV Epidemic (EHE), as a unique access point for cisgender women in the U.S. who account for approximately 1 in 5 new HIV infections. Biomedical HIV prevention, known as PrEP, is effective for cisgender women, yet uptake remains low and rates of new infections among women have remained steady while other key populations have experienced declines. Further, significant racial disparities persist in PrEP uptake and HIV acquisition, with Black women accounting for almost 60% of new cases. Low risk perception, lack of knowledge, and insufficient access to biomedical HIV prevention in sexual health service settings contribute to this. Despite receiving federal funds to provide free and low-cost family planning and preventative sexual health services, Title X clinics do not routinely provide PrEP as part of their services; this excludes the millions of U.S. women who engage in sexual behaviors aligned with HIV risk from access to effective prevention when utilizing Title X clinics for care.

Methods: In the course of developing a systems-level bundle of tailored implementation strategies to support PrEP care delivery in Title X-funded family planning clinics, we conducted a series of baseline focus groups with staff and providers at Title X family planning clinics located in 4 EHE priority jurisdictions that comprise metro Atlanta. The analysis of these focus groups aimed to elucidate important considerations and needs to inform implementation strategy development and strengthen PrEP care delivery in these safety-net clinics.

Results: This article describes the findings from these focus groups and recommendations and next steps for scaling PrEP in Title X family planning clinics in the Southern U.S. to improve PrEP reach among cisgender women.