Cabecinha, Melissa Ann; (2024) Awareness, knowledge, and perceptions of HIV pre-exposure prophylaxis (PrEP) among women in England: A mixed methods exploration through an equity lens. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: HIV Pre-exposure prophylaxis (PrEP) is a powerful biomedical tool for HIV prevention. In England, PrEP has routinely been available from sexual health services since October 2020. Despite accounting for ~20% of new HIV diagnoses in 2021, <2% of PrEP users were women. In this thesis, complementary methods are used to investigate awareness, knowledge, and perceptions of PrEP among women in England through an equity lens in order to inform policies and practice that may increase HIV prevention access and engagement in this population. Methods: A systematic review of observational studies in high-income countries which explored definitions “PrEP awareness” and “PrEP interest” and whether factors known to influence health equity were considered when reporting outcome measures. Eighteen semi-structured interviews with women resident in England to explore their awareness, knowledge, and perceptions of PrEP and PrEP implementation. An online, self-completion, cross-sectional convenience survey of 974 women resident in England to investigate the sample’s level of awareness of and preferences for PrEP. Sample characteristics were compared to the most recent census data, and logistic regression was used to identify associations between PrEP interest and awareness and sociodemographic and other factors that influence health equity. Results: Findings from the systematic review suggest that there is a lack of consistency in the definitions of PrEP awareness and PrEP interest in the published literature. Qualitative evidence suggests that a lack of awareness, knowledge gaps, and assumptions around PrEP eligibility contribute to low PrEP coverage among women. Quantitative evidence suggests that awareness of PrEP is associated with previous engagement in HIV prevention and that current PrEP provision services may not meet the preferences of women. Conclusion: To improve equitable access to PrEP, education and awareness campaigns should include women-specific information and clear indications for PrEP candidacy. Addressing HIV stigma, integrating HIV prevention in conversations around sexual health, and expanding PrEP provision outside of sexual health services may help increase the accessibility of PrEP and PrEP information for women.

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