Exploring the barriers and facilitators to HIV Pre-Exposure Prophylaxis (PrEP) access

At NIHR ARC NWL we support researchers at all stages of their careers to investigate the health and care issues most important to populations in Northwest London.

PhD student Flav Coukan is seeking participants to contribute to the study named ‘Modifiable factors affecting HIV PrEP access: A qualitative study to investigate co-design strategies to develop new PrEP delivery and accessibility recommendations in underserved populations in England.’ The study aims to improve the equitable delivery of HIV Pre-Exposure Prophylaxis (PrEP) in England for Black women.

A deep dive into PrEP

PrEP is an HIV prevention method that has been available for free on the NHS in sexual health services since March 2020 by which someone at risk of HIV acquisition takes antiretroviral drugs to prevent HIV acquisition.

The research team, including members from our Patient, Public, Community Engagement and Involvement Theme, are specifically interested in the sexual health experiences (in the context of HIV prevention) of women of Black ethnicity, a population currently underserved by the delivery of this prevention method. The team are also interested in the experiences of clinicians and other healthcare professionals and local authority commissioners that are involved in the commissioning and delivery of PrEP in sexual health services.

Comparing perspectives

The participants will initially discuss barriers and facilitators to PrEP access in focus groups and will then contribute to new recommendations on how to make PrEP more accessible in co-design workshops. Researchers will then compare the suitability standard policy-making led by commissioners and healthcare professionals to the recommendations co-produced by black women.

The study is likely to influence the way PrEP is promoted and delivered, putting England one step closer to ending the spread of HIV by 2030.

"Why do we have this problem?"

Flav commented: “The idea for this PhD project came from personal experiences: I was unable to obtain PrEP for myself despite working for the PrEP Impact Trial (the precursor to the commissioned programme in England) as a data analyst and data manager. This had me wondering “Who else has this issue? Why do we have this problem? Can this be avoided in the future?”. Despite the Department of Health and Social Care making PrEP freely available on the NHS in March 2020, it was clear that some of these issues have not been addressed as part of the commissioned programme.

"This is what got me to where I am today. In an effort to make PrEP services more equitable, I have summarised the evidence on the factors that facilitate and hinder PrEP access and have undertaken an analysis of the PrEP Impact Trial that showed that women of Black ethnicity were the most underserved by PrEP.

"I hope that this work can have significant impact of improving PrEP delivery in England and make the commissioned PrEP programme more equitable as a result of this final qualitative study."