(P297) Barriers and Facilitators of HIV Pre-Exposure Prophylaxis Services in an Obstetrics-Gynecology Clinic in Alabama: A Qualitative Analysis

Background: HIV disproportionately affects Black women in the Southern U.S., yet utilization of HIV pre-exposure prophylaxis (PrEP) for HIV prevention among cis-gender women remains low, with particularly inequitable access among Black women. Gynecology clinics provide an ideal location for PrEP services, alongside already-available sexual, reproductive, and primary health care services for many cis-gender women.

Methods: We conducted qualitative in-depth interviews with key informants at a gynecology continuity clinic serving under- and uninsured women in Alabama to evaluate individual-, setting-, and process-level determinants of PrEP care provision. The clinic serves approximately 3,000 women yearly, 64% of whom are Black women. Interview guides utilized the Information-Motivation-Behavioral Skills Model to explore barriers and facilitators affecting PrEP implementation, including provider knowledge about PrEP, motivations to integrate PrEP into routine gynecologic care, and skills needed to deliver PrEP care. A codebook was developed from interview transcripts, and further detailed inductive codes were developed by the study team. Interviews were coded by two team members to identify emergent themes.

Results: Seven key informants participated in interviews, with a mean age of 33 years and positions including, among others, attending and trainee physicians (Table 1). The following themes emerged: (1) Gynecology providers discuss sexual health with their patients, but rarely discuss PrEP; (2) Providers support an interdisciplinary team approach to PrEP implementation, inclusive of physicians, advanced practice providers, nurses, medical assistants, and office staff; (3) Longitudinal and iterative provider education on PrEP is an important motivator for discussions about PrEP with patients; (4) Providers need communication and cultural competency skills to build trust and rapport with patients, which ameliorate community stigma around discussions about HIV prevention.

Conclusion: PrEP implementation in gynecology clinics can improve access to HIV prevention for cis-gender Black women in Alabama. Increasing provider knowledge about PrEP provision and care boosts provider confidence discussing PrEP with patients. Utilizing an interdisciplinary approach across clinic staff may normalize PrEP discussions, allowing patients time to ask questions at many intervals with providers trained on providing culturally appropriate care. These findings will inform development of implementation strategies to integrate PrEP care into routine gynecologic care in the American South.