Improving delivery of HIV pre-exposure prophylaxis among key populations in England
File(s)
Author(s)
Coukan, Flavien
Type
Thesis
Abstract
This mixed method thesis investigates ways to improve HIV Pre-Exposure Prophylaxis (PrEP) access in England by identifying barriers and facilitators to its use in the most underserved population and investigating effective participatory practices for developing interventions. First, a systematic review identified a lack of evidence on the barriers faced by non-MSM populations and the provider and system-level factors. Using the novel PrEP-to-need ratio (PnR) metric of equity, I subsequently investigated which populations were most underserved by PrEP in England following its commissioning in 2020. I found a growing gender-based equity gap post-commissioning, compounded by ethnicity, resulting in Black women being the most underserved.
I used a participatory approach and focus group (FG) discussions with Black women, healthcare professionals (HCPs) and mixed groups to investigate the modifiable barriers and facilitators for Black women’s access to PrEP. The Capability, Opportunity, Motivation and Behaviour (COM-B) model of behaviour change identified how provider and system-level barriers impact patient-level factors and Black women’s motivation to use PrEP; the most important barrier was the lack of HIV and PrEP knowledge. In subsequent workshops, participants co-designed interventions to address this barrier: all workshops co-designed interventions aimed at increasing HIV and PrEP knowledge via multimodal PrEP educational campaigns that combined national mass media and local community events.
Due to the similarities in campaign designs, I could not ascertain which participatory approach developed the most effective intervention to tackle the lack of HIV and PrEP knowledge barrier via theoretical analysis, and it will be required to pilot those interventions to do so. However, the participatory nature of this project highlights the purpose of PPIE activities: involvement is not about improving research or policy outputs but a democratic exercise that balances power dynamics to build trust, often lacking between researchers/policymakers and the public/patients, especially among racially minoritised populations.
I used a participatory approach and focus group (FG) discussions with Black women, healthcare professionals (HCPs) and mixed groups to investigate the modifiable barriers and facilitators for Black women’s access to PrEP. The Capability, Opportunity, Motivation and Behaviour (COM-B) model of behaviour change identified how provider and system-level barriers impact patient-level factors and Black women’s motivation to use PrEP; the most important barrier was the lack of HIV and PrEP knowledge. In subsequent workshops, participants co-designed interventions to address this barrier: all workshops co-designed interventions aimed at increasing HIV and PrEP knowledge via multimodal PrEP educational campaigns that combined national mass media and local community events.
Due to the similarities in campaign designs, I could not ascertain which participatory approach developed the most effective intervention to tackle the lack of HIV and PrEP knowledge barrier via theoretical analysis, and it will be required to pilot those interventions to do so. However, the participatory nature of this project highlights the purpose of PPIE activities: involvement is not about improving research or policy outputs but a democratic exercise that balances power dynamics to build trust, often lacking between researchers/policymakers and the public/patients, especially among racially minoritised populations.
Version
Open Access
Date Issued
2024-03-05
Date Awarded
01/10/2024
License URL
Advisor
Ward, Helen
Atchison, Christina
Saunders, John
Sponsor
National Institute for Health Research (Great Britain)
British HIV Association
Imperial College London
Publisher Department
School of Public Health
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)