UCSF/East Bay AIDS Center: CRUSH-PrEP for Women

The current medical consensus on the use of daily oral anti-retroviral pre-exposure prophylaxis (PrEP) to prevent HIV is  that PrEP is a promising prevention strategy. Although the FDA approved the use of Truvada™ as PrEP for men and women in 2012, many communities vulnerable to HIV have little or no knowledge about this highly effective strategy for preventing HIV transmission. Research supports PrEP’s effectiveness for HIV negative men who have sex with men (MSM) and their willingness to access it as a prevention strategy. While heterosexual women also are willing and interested in PrEP, dissemination strategies are critical because HIV infection rates among U.S. women average 10,000 each year and account for approximately 20% of new cases overall. PrEP demonstration projects in cities around the U.S. have generated free access to PrEP and as a consequence have led to increased knowledge and acceptability of PrEP.

Unfortunately, women have been largely excluded in these PrEP demonstration projects, which makes this funding opportunity very important. There is evidence of demand for PrEP among women.  In a study of pharmacies, researchers sampled 55% of U.S. pharmacies to assess whether women were accessing PrEP and found that between January 2012 and March 2014, 42% of the PrEP users identified were women. Furthermore, while the clinical science on PrEP efficacy is clear, the social and behavioral implications of PrEP use among women are less so. Perhaps women desire a prevention method that they can control or prefer PrEP because it is convenient and easy to use. In any case, to answer questions about real-world use of PrEP by women and to ascertain the “promise” of PrEP among them, we propose to integrate PrEP into two primary care clinics serving women who are at disproportionate risk of infection in geographic areas with a high density of HIV. We will study whether women seen in these primary care settings are interested in and willing to use PrEP as a prevention strategy. We will also assess whether the availability of PrEP draws women into primary care services who are not currently in care. In our proposed study, we plan to build on the expertise we have gained during development and implementation of our current California HIV/AIDS Research Program-funded demonstration project - Connecting Resources for Urban Sexual Health (CRUSH) - which provides PrEP to young gay men and transwomen of color in Oakland, California. In the proposed supplemental CRUSH-PrEP for Women project, we plan to provide access to PrEP to 50 women and to follow them over a 15- month period. To accomplish these goals, we propose the following aims: 1) to assess uptake of and adherence to PrEP among women in the study; 2) to assess the characteristics of women who enroll in the PrEP study and their relationship to adherence and uptake and; 3) to assess the referral sources of women who enroll in the PrEP study.