"I honestly didn't know it was for women too…" Acceptability and feasibility of integrating PrEP services into OB/GYN practices from the perspectives of practice staff and cisgender women in the community: a Qualitative Study

Christine M Khosropour^1*Elise Healy¹Emma M Murphy¹Arianna Rubin Means¹Erykah Pasha²Jaelyn Howard²Emani Gonzalez²Tiffany D Lloyd²Bethany Spier³Cathy J Berry³Kandis V Backus⁴

• ¹University of Washington, Seattle, United States
• ²Layla's Got You, Syracuse, United States
• ³Cathy J. Berry and Associates, Syracuse, United States
• ⁴Gilead (United States), Foster City, California, United States

Background: HIV pre-exposure prophylaxis (PrEP) is effective at preventing HIV but uptake among cisgender women in the United States (US) is suboptimal. Most US cisgender women receive care in private practice settings, but PrEP has not been routinely integrated there. We investigated barriers and facilitators to integrating PrEP into women’s health practices.Methods: In upstate New York in 2023, we conducted two focus group discussions (FGDs) with 22 cisgender women of color. Discussions focused on patient awareness/knowledge of PrEP, experiences accessing sexual healthcare, and preferences in services offered. We concurrently conducted one-on-one in-depth interviews (IDI) with 11 clinical staff (medical assistants, nurses, physicians/midwives) in an obstetrics/gynecology private practice. Interviews focused on staff awareness/knowledge of PrEP, desire to offer PrEP, and barriers/facilitators to integrating PrEP into practice flow. Thematic analysis, informed by the COM-B and Theoretical Domains Framework, was used to identify determinants of integration.Results: The median age of FGD participants was 20 and 72% identified as Black. Key themes included: low awareness of and misconceptions about PrEP (e.g., PrEP is for gay men); perceived stigma about PrEP (e.g., PrEP implies multiple sexual partnerships); previous negative experiences seeking medical care (e.g., feeling judged); desire for healthcare settings to integrate PrEP as part of holistic reproductive healthcare. Clinical staff had low awareness of and misconceptions about PrEP. Barriers to integrating PrEP included: lack of PrEP knowledge, lack of time to integrate PrEP services within routine visits, challenges with billing insurance for integrated services, and heterogeneity in comfort with sexual health discussions with patients. Facilitators included staff buy-in to provide PrEP and willingness to adapt clinical protocols to integrate PrEP, rooted in recognition that HIV prevention is important for their patients and community. Conclusions: Similar misconceptions about PrEP exist among cisgender women in the community and clinical providers in private practice, but both groups recognize the importance of expanding PrEP access. Despite high motivation to prescribe PrEP, there are unique structural barriers to integrating PrEP in the private practice setting (e.g., insurance and billing). Directly addressing shared and distinct patient and provider-level concerns may facilitate integration of PrEP services in private practices.