Pre-exposure prophylaxis (PrEP) is an effective prevention strategy for individuals who are at substantial risk for HIV. According to the CDC, approximately 180,000 sexually active U.S. women of reproductive age are potential candidates for PrEP. But awareness and uptake of PrEP among women has been limited, especially among African-American and Hispanic/Latina women who are disproportionately affected by HIV. Barriers include lack of awareness, stigma associated with HIV, reluctance to discuss risk behaviors with providers to avoid judgment, and the cost of PrEP. In addition, barriers for women, particularly women of color, also include provider bias or discouragement; distrust of healthcare systems and ”new” medications; frequency of medical visits; and cultural gendered norms around sexuality and sexual practice.
My office, the HHS Office of Population Affairs (OPA), with support from the Secretary’s Minority AIDS Initiative Fund, developed the Decision-Making Guide for the Provision of PrEP Services in Title X-Funded Sites [PDF, 1.5MB] to help Title X family planning service sites make evidence-informed decisions about their role in assuring access to PrEP for HIV prevention services in their communities. The Title X family planning program is the only federal program dedicated solely to providing family planning and related preventive health services. As a primary source of care for many women in the U.S., Title X service sites are in a prime position to address the disparities in PrEP awareness and access among women to advance HIV prevention practices across the country. Currently, nearly 90 percent of Title X sites provide HIV testing and approximately one-third of sites offer PrEP.
The Decision-Making Guide is an organizational tool for family planning organizations to consider their current level of PrEP service provision, if any, and the resources required to provide a level of service that assures access to PrEP services in their communities. This new resource explains key decision-making factors for PrEP services and features an organizational checklist to help clinic leadership and administrators evaluate the site’s capacity and organizational readiness for PrEP service delivery based on their clients’ needs. While this resource was initially intended for Title X-funded agencies, it may also be a useful resource for other organizations offering family planning and related preventive health services.
Formative research for the development of the Guide occurred over a two-year period, during which we conducted informational interviews with Title X sites, completed an in-depth literature review, convened a panel of experts, and launched a pilot project to assess the use of the Guide in Title X sites across the country. The informational interviews highlighted several key considerations for PrEP implementation including meeting service provision needs for clients who would benefit from PrEP services, staff education needs and the cost of PrEP service implementation (staff labor and training, lab work, and PrEP medication). Participants on the expert panel, representing federal agencies, community-based organizations, family planning training centers, and Title X grantee sites, provided invaluable input for the development of the decision-making tool.
This past year, we led a 12-week pilot project to assess how Title X sites would use the Guide in practice. Pilot project findings indicated that this new tool helped increase pilot sites’ organizational readiness for PrEP service implementation. Previously, many of the pilot sites had only thought about offering PrEP services. Subsequently, the majority of the pilot sites were leaning in the direction of offering PrEP services or had made the decision to offer PrEP services.