To assess PrEP service delivery preferences among Black cis-gender women living in urban and rural settings in Alabama, we conducted a cross-sectional discrete choice experiment survey. Discrete choice experiments included five attributes. Hierarchical Bayes (HB) modeling and latent class analyses (LCA) were used to evaluate attribute preferences. Among 795 Black cis-gender HIV-negative women, almost two-thirds lived in urban settings and reported having at least some college; about a third reported a household income less than $25,000 annually; and reported willingness to use PrEP. Respondents placed the greatest importance on PrEP medication formulation and healthcare facility. LCA showed the group with the highest rural proportion preferred for on-line visits. Black women in the Deep South had distinct preferences regarding PrEP service delivery. These findings can inform tailored interventions to improve PrEP uptake among Black cis-gender women across diverse settings in the South.

Background HIV pre-exposure prophylaxis (PrEP) can decrease HIV incidence among several high-risk populations. In order to successfully implement PrEP, healthcare providers will need to have knowledge about counselling, monitoring and drug adherence. This study was carried out to determine the awareness, practice and preparedness of healthcare professionals to prescribe PrEP in clinical settings especially to key populations in our communities and identify the factors associated with or encouraging its prescription. Methods This cross-sectional study was carried out in randomly selected primary, secondary and tertiary level hospitals in Western Nigeria. The target population were physicians and nurses largely involved in the antiretroviral clinics in the hospitals. Data was collected by trained volunteers and supervised by appointed supervisors by a face-to-face interview. All data were statistically analysed, using Statistical Package for the Social Sciences (SPSS) and statistical test of significance was performed with Chi-Square test. Results A total of 256 consenting respondents participated in the study with a mean age ± SD of 38.52 ± 9.29 years. A total of 89.8% of the respondents have heard about PrEP, with 54.3% of them aware of both oral and topical PrEP while only 4.3% have ever prescribed PrEP. The main factor associated with PrEP prescription was work experience (c² = 20.815, df = 1, p = 0.001). Work experience has lower association with PrEP prescription (OR: 0.88, 95% CI: 0.82-0.95). Conclusion Healthcare professionals in public hospitals in Nigeria are PrEP aware and willing to prescribe, but few have actually ever done the prescription. Regular supply of drugs for pre-exposure prophylaxis purpose and addressing the potential safety issues and medication-related adverse effects will help aid the PrEP implementation effort nationwide especially with focus on the key populations of mem having sex with (MSM) who are in a hostile environment in our own neighbourhood. Disclosure No significant relationships.

Background The severity of the HIV epidemic in the United States’ rural South highlights geographic, socioeconomic, and racial disparities that disproportionately affect poor Black Americans. Approximately 16% of Alabamians living with HIV remain undiagnosed and just 37% of rural Alabamians have ever been tested for HIV. Methods We conducted in-depth interviews with 22 key stakeholders involved in HIV prevention, testing, treatment, or community health initiatives, and 10 adults living in rural communities across Alabama to explore HIV testing challenges and opportunities. We utilized a rapid qualitative analysis approach and engaged community partners for feedback and discussion. This analysis will inform the implementation of a mobile HIV testing service in rural Alabama. Results The following themes were identified: (1) Cultural norms, racism, poverty, and rurality impair access to healthcare. (2) Lack of sex education, low knowledge of HIV and perception of risk reinforce stigmas. (3) Messaging about “Undetectable = Untransmissible” (U = U) is not well understood in communities. (4) Community involvement may promote communication and trust between communities and testing advocates. (5) Novel testing strategies are acceptable and may diminish barriers. Conclusions Working with community “gatekeepers” may be a key strategy to understand and promote acceptability of interventions new to rural Alabama and ameliorate stigma within communities. The implementation of new HIV testing strategies requires building and maintaining relationships with advocates, especially faith-based leaders, who engage people across many demographics.

Background: The severity of the HIV epidemic in the United States’ rural South highlights geographic, socioeconomic, and racial disparities that disproportionately affect poor Black Americans. Approximately 16% of Alabamians living with HIV remain undiagnosed and just 37% of rural Alabamians have ever been tested for HIV. Methods: We conducted in-depth interviews with 22 key stakeholders involved in HIV prevention, testing, treatment, or community health initiatives, and 10 adults living in rural communities across Alabama to explore HIV testing challenges and opportunities. We utilized a rapid qualitative analysis approach and engaged community partners for feedback and discussion. This analysis will inform the implementation of a mobile HIV testing service in rural Alabama.Results: The following themes were identified: (1) Cultural norms, racism, poverty, and rurality impair access to healthcare. (2) Lack of sex education, low knowledge of HIV and perception of risk reinforce stigmas. (3) Messaging about “Undetectable = Untransmissible” (U=U) is not well understood in communities. (4) Community involvement may promote communication and trust between communities and testing advocates. (5) Novel testing strategies are acceptable and may diminish barriers.Conclusions: Working with community “gatekeepers” may be a key strategy to understand and promote acceptability of interventions new to rural Alabama and ameliorate stigma within communities. The implementation of new HIV testing strategies requires building and maintaining relationships with advocates, especially faith-based leaders, who engage people across many demographics.