Family planning providers' role in offering PrEP to women

Abstract

Pre-exposure prophylaxis (PrEP) provides a radically different HIV prevention option for women. Not only is PrEP the first discrete, woman-controlled method that is taken in advance of exposure, but it is both safe and highly effective, offering over 90% protection if taken daily. While multiple modalities of PrEP are in development ranging from vaginal rings to injectables and implants, only PrEP with oral tenofovir/emtricitabine is currently FDA-approved. Family planning clinics provide key access points for many women to learn about and obtain PrEP. By incorporating PrEP services into family planning care, family planning providers have the opportunity to meet women's expectations, ensure women are aware of and offered comprehensive HIV prevention options, and reverse emerging disparities in PrEP access. Despite real and perceived barriers to integrating PrEP into family planning care, providing PrEP services, ranging from education to onsite provision, is not only possible but an important component of providing high-quality sexual and reproductive healthcare to women. Lessons learned from early adopters will help guide those in family planning settings initiating or enhancing PrEP services.

Depression and HIV risk behaviors among adolescent girls and young women seeking family planning services in Western Kenya

“…11,82 Expanding counseling topics in FP clinics to include depression screening and discussion of HIV prevention methods is a natural next step to address these intersecting health issues. 29,30 Tailored counseling may be required to support AGYW with MSD to navigate HIV prevention, including PrEP use and adherence, directly addressing their depression as a potential barrier to motivation and self-efficacy.…”

“…FP services are some of the most readily accessed health services by AGYW in SSA with over a third of reproductive-aged women using modern contraceptive methods in the region. [26][27][28] HIV prevention counseling is increasingly implemented via FP services within high HIV-burden settings, [29][30][31] and Kenya is one of the first countries in SSA to programmatically offer pre-exposure prophylaxis (PrEP) to AGYW in FP clinics. 31,32 AGYW in SSA who regularly access FP could similarly be reached with clinic-based mental health programs; yet, no studies to date have evaluated depression among AGYW seeking FP services.…”

PrEP in Primary Care; Health Care Worker Adaptations to PrEP Delivery in Eswatini

“…These approaches may also speci cally address women's access to, and ability to take PrEP which here -and in other studies -is described as disrupted by fear of violence and disapproval from male sexual partners [46][47][48]. Adopting our HCWs' suggestions for providing PrEP to women -such as PrEP in combination with other services, male partner engagement and a further safety assessment -may support women in both access to and continued use of PrEP [49][50][51].…”

Integrating HIV Pre-Exposure Prophylaxis into Family Planning Care: A RE-AIM Framework Evaluation

“…Women's health and HIV prevention experts have called for increasing access to HIV prevention and PrEP in settings that provide family planning services to women. [4][5][6] PrEP with daily tenofovir/emtricitabine (Truvada Ò ) reduces transmission of HIV by up to 92%. [7][8][9] CDC and American College of Obstetricians and Gynecologists (ACOG) recommend HIV PrEP for women who ''engage in sexual activity in a high prevalence area'' and inconsistently use condoms.…”

“…Most providers reported interest in learning about PrEP and the majority of family planning patients reported they would consider using PrEP, but providers reported multiple barriers to PrEP provision, including insufficient provider education, patient costs, and time constraints. 12 While suggestions have been made regarding implementation of PrEP for women, 6 the feasibility, facilitators, and barriers to the integration of HIV PrEP services in family planning settings have not been systematically investigated.…”