Co-designing interventions with multiple stakeholders to address barriers and promote equitable access to HIV Pre-Exposure Prophylaxis (PrEP) in Black women in England
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background:
Black women are among the populations most underserved by HIV pre-exposure prophylaxis (PrEP) in England, despite higher risk of HIV acquisition. Previous research mostly focused on men who have sex with men (MSM), often neglecting Black women, and overfocused on patient-level barriers while overlooking provider and system-level factors. This study addresses these gaps by investigating barriers and facilitators to PrEP access by involving multiple stakeholders and exploring co-design strategies to tackle these barriers.
Methods:
The study used a structured two-phased qualitative approach. In Phase 1, focus groups (FG) were undertaken across three stakeholder streams: Black women, healthcare professionals (HCPs), and a group combining Black women and HCPs. FG allowed for consensus-building exercises on key barriers and facilitators to PrEP access, and their transcripts were analysed via thematic framework analysis using the Capability, Opportunity, Motivation and Behaviour model of behaviour change. In Phase 2, co-design workshops were conducted with the same stakeholder groups to develop interventions targeting the barrier identified as most important using the Behaviour Change Wheel framework. Interventions were evaluated against the APEASE criteria.
Results:
Phase 1 identified six key barriers: HIV/PrEP knowledge gaps, restrictive policies, cultural stigma, healthcare system distrust, gendered relationship dynamics, and suboptimal PrEP use. Six facilitators emerged, including improved knowledge, increased accessibility, and addressing discrimination. All stakeholder groups voted for lack of awareness and knowledge as the priority barrier to address. All co-designed interventions consisted of a multimodal PrEP awareness campaign tailored to Black communities, with an emphasis on Black women’s involvement to foster trust and engagement. However, the workshops produced different approaches, with Black women focusing on community-led initiatives, and HCPs advocating for government-backed, broader strategies despite known distrust of institutions.
Conclusions:
This study highlights the importance of co-designing interventions with Black women to address multi-level barriers to PrEP access. It underscores the need for community education, healthcare system reforms, and the inclusion of Black women in decision-making processes to reduce PrEP equity gaps. The co-designed interventions provided a tailored, context-specific strategy that could improve PrEP uptake among Black women in England.
Black women are among the populations most underserved by HIV pre-exposure prophylaxis (PrEP) in England, despite higher risk of HIV acquisition. Previous research mostly focused on men who have sex with men (MSM), often neglecting Black women, and overfocused on patient-level barriers while overlooking provider and system-level factors. This study addresses these gaps by investigating barriers and facilitators to PrEP access by involving multiple stakeholders and exploring co-design strategies to tackle these barriers.
Methods:
The study used a structured two-phased qualitative approach. In Phase 1, focus groups (FG) were undertaken across three stakeholder streams: Black women, healthcare professionals (HCPs), and a group combining Black women and HCPs. FG allowed for consensus-building exercises on key barriers and facilitators to PrEP access, and their transcripts were analysed via thematic framework analysis using the Capability, Opportunity, Motivation and Behaviour model of behaviour change. In Phase 2, co-design workshops were conducted with the same stakeholder groups to develop interventions targeting the barrier identified as most important using the Behaviour Change Wheel framework. Interventions were evaluated against the APEASE criteria.
Results:
Phase 1 identified six key barriers: HIV/PrEP knowledge gaps, restrictive policies, cultural stigma, healthcare system distrust, gendered relationship dynamics, and suboptimal PrEP use. Six facilitators emerged, including improved knowledge, increased accessibility, and addressing discrimination. All stakeholder groups voted for lack of awareness and knowledge as the priority barrier to address. All co-designed interventions consisted of a multimodal PrEP awareness campaign tailored to Black communities, with an emphasis on Black women’s involvement to foster trust and engagement. However, the workshops produced different approaches, with Black women focusing on community-led initiatives, and HCPs advocating for government-backed, broader strategies despite known distrust of institutions.
Conclusions:
This study highlights the importance of co-designing interventions with Black women to address multi-level barriers to PrEP access. It underscores the need for community education, healthcare system reforms, and the inclusion of Black women in decision-making processes to reduce PrEP equity gaps. The co-designed interventions provided a tailored, context-specific strategy that could improve PrEP uptake among Black women in England.
Date Issued
2025-05-17
Date Acceptance
2025-05-02
Citation
BMC Public Health, 2025, 25 (1)
ISSN
1471-2458
Publisher
BMC
Journal / Book Title
BMC Public Health
Volume
25
Issue
1
Copyright Statement
© The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Publication Status
Published
Article Number
ARTN 1831
Date Publish Online
2025-05-17