Strategies for increasing impact, engagement, and accessibility in HIV prevention programs: suggestions from women in urban high HIV burden counties in the Eastern United States (HPTN 064)

• Type of Material: Article
• Authors: Jasmine A. Abrams, Boston University; Michelle Odlum, Columbia University; Emily Tillett, University of Maryland; Danielle Haley, Boston University; Jessica Justman, Columbia University; Sally Hodder, West Virginia University; Linda Vo, Emory University; Ann O'Leary, Centers for Disease Control and Prevention; Paula Frew, Emory University
• Language: English
• Date: 2020-09-03
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2020.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12889-020-09426-6
• Title of Journal or Parent Work: BMC Public Health
• Volume: 20
• Grant/Funding Information: National Institute of Allergy and Infectious Diseases, National Institute on Drug Abuse, and National Institute of Mental Health (cooperative agreement no. UM1 AI068619, UM 1AI068617, and UM1-AI068613);; Danielle Haley received support from EU’s Laney Graduate School Robert W. Woodruff pre-doctoral fellowship and the National Institute on Drug Abuse (7K01DA046307).; Emory University (EU) HIV/AIDS Clinical Trials Unit (5UO1AI069418) and Clinical and Translational Science Award (UL1 RR025008); The Terry Beirn Community Programs for Clinical Research on AIDS Clinical Trials Unit(5 UM1 AI069503–07) and; The Johns Hopkins Adult AIDS Clinical Trial Unit (AI069465) and The Johns Hopkins Clinical and Translational Science Award (UL1 RR 25005).; Jasmine Abrams received funding to complete this manuscript from the HPTN Scholars Program. As the study was conducted as part of the NIH HPTN network, NIH staff served on the HPTN 064 study protocol team, and as a result were actively involved in the design, implementation, interpretations of analyses, and manuscript development. This level of involvement is typical of HPTN studies.; Paula Frew received additional support from the Health for Nevada, Health Disparities Research Initiative. Trial Registration Information Clinicaltrials.gov, NCT00995176.; University of North Carolina (UNC) Clinical Trials Unit (AI069423); UNC Clinical Trials Research Center of the Clinical and Translational Science Award (RR 025747); UNC Center for AIDS Research (AI050410);; The Emory Center for AIDS Research (P30 AI050409), Centers for Innovative Research to Control AIDS, Mailman School of Public Health, Columbia University (5U1Al069466)
• Keywords: HIV hotspots; PrEP; Implementation science; Sexual health; Biobehavioral intervention
• Research Categories: Health Sciences, Immunology; Psychology, Social; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Background Merely having the tools to end HIV is insufficient. Effectively ending the epidemic necessitates addressing barriers that impede engagement in biomedical and behavioral prevention and wide scale implementation and utilization of existing interventions. This qualitative study identifies suggestions for increasing access to, engagement in, and impact of HIV prevention among women living in cities in high HIV burden counties in the eastern US. Methods Data analyzed for the current study were collected via a qualitative sub-study within the HIV Prevention Trials Network Study 064 (HPTN 064), a multisite observational cohort study designed to estimate HIV incidence among women residing in communities with elevated HIV prevalence who also reported personal or partner characteristics associated with increased risk of HIV acquisition. Focus group and interview participants in the qualitative sub-study (N = 288) were from four cities in the eastern US. Results Thematic analyses revealed four themes describing women’s most frequently stated ideas for improving prevention efforts: 1) Promote Multilevel Empowerment, 2) Create Engaging Program Content, 3) Build “Market Demand”, and 4) Ensure Accessibility. We conducted additional analyses to identify contradictory patterns in the data, which revealed an additional three themes: 1) Address Structural Risk Factors, 2) Increase Engagement via Pleasure Promotion, 3) Expand Awareness of and Access to Prevention Resources. Conclusions Findings may be useful for enhancing women’s engagement in and uptake of behavioral and biomedical HIV prevention resources, improving policy, and addressing multilevel risk factors.