Integration of pre-exposure prophylaxis education at family planning clinics
Awarded 2015
Complex Family Planning Fellowship Research
Dominika Seidman, MD
University of California, San Francisco

Background and Purpose: The Center for Disease Control and Prevention (CDC) and the Office of Population Affairs state sexually transmitted infection prevention is a core family planning service. Pre-exposure prophylaxis is a method of HIV prevention in which an HIV-negative individual takes antiretroviral medications before and after exposure for an indefinite period of time during periods of increased vulnerability to HIV. The United States Food and Drug Administration approved tenofovir and emtricitibine, co-formulated as Truvada, as pre-exposure prophylaxis for HIV prevention in men and women in 2012. In 2015, the CDC estimated 468,000 women in the United States (0.6% of adult women) met criteria for pre-exposure prophylaxis (PrEP) for HIV prevention, including having condomless sex in the prior 6 months with a man living with HIV, a man who has sex with men, or a man who injects drugs.
The United States Women and PrEP Working Group, an advocacy group for women and HIV prevention, identifies family planning clinics as key clinical sites to identify women vulnerable to HIV and offer HIV pre-exposure prophylaxis. They argue that over one-third of US women exclusively access healthcare through reproductive healthcare providers, and therefore family planning clinics are an efficient and logical venue for women to learn about and receive HIV prevention services. However, there are limited data on the proportion of family planning clients eligible for PrEP, and no data on family planning clients’ knowledge of PrEP and interest in PrEP education and/or services at the time of their visits.
The objective of this study was to assess family planning clients’ knowledge of PrEP, interest in integrated sexually transmitted infection and family planning care and specifically PrEP education at the time of a family planning visit, and worry about HIV acquisition in the setting of known vulnerabilities to HIV.
Methods: We surveyed women presenting for family planning care at 2 Bay Area Planned Parenthood clinics and 3 San Francisco General Hospital-affiliated clinics. We recruited women 13-45 years old who spoke English or Spanish, were presenting for family planning services, and were not living with HIV. Women answered surveys anonymously on iPads.
Results: 2,005 women completed surveys and 1969 were eligible for analysis. The majority of women (80%) desired integrated sexual and reproductive healthcare counseling. Seven percent of women (118/1700) met CDC criteria for PrEP, and this did not vary by reason for presentation (abortion vs. other family planning care). Women’s concerns for HIV acquisition correlated with known risk factors for HIV acquisition. Women had little knowledge of pre-exposure prophylaxis for HIV prevention, with lower knowledge among non-White women and women with less education. Approximately one quarter of women were interested in pre-exposure prophylaxis on the day of their visit, and this was more likely if women had a known risk factor for HIV, were very worried about HIV acquisition, were not White, had less education, and exclusively accessed reproductive healthcare.
Conclusions: Family planning clinics care for a large proportion of women who meet CDC criteria for PrEP. Many of these women only receive healthcare through family planning clinics, and therefore are unlikely to learn about and access PrEP elsewhere. While further research is needed to understand women’s preferences around PrEP, family planning clinics should offer PrEP education and services to ensure women access comprehensive HIV prevention care. Provider trainings are underway and implementation studies are needed to support integration of PrEP education and services into family planning care.