HIV biomedical prevention knowledge, attitudes, and behaviors among U.S. women enrolled in a longitudinal cohort study 2014-2019.

BACKGROUND: Pre-exposure prophylaxis (PrEP) was approved for use in the US in 2012 and cross-sectional analyses show low uptake among women. However, use of PrEP over time has not been characterized in women. Longitudinal assessments are needed to characterize PrEP use and eligibility. METHODS: We conducted a nested cross-sectional survey (April 2014-October 2015) to assess post-exposure prophylaxis (PEP)/PrEP knowledge, attitudes, and PEP/PrEP use among cisgender women without HIV enrolled in the Women's Interagency HIV Study (WIHS). As few women reported PEP/PrEP use we assessed willingness to use PEP/PrEP. Longitudinally, we determined PrEP use and eligibility based on CDC guidance using semi-annual self-reported risk behaviors collected from 2014 to 2019. We used logistic regression to identify factors associated with willingness to use PrEP. RESULTS: Among the 716 women who completed the survey the median age was 46 years (IQR 38, 53) and 72% were Black. At baseline, 43% (n = 46/108) of PrEP-eligible women self-identified as medium-high risk for HIV while 8% (n = 47/593) of non-eligible women believed they were at high risk. 36% (n = 264/731) of women were eligible for PrEP at some point between 2014 and 2019. However, only 3% (n = 22/731) of women reported PrEP use. Older age (aOR 0.97 95% CI 0.95-0.99) and ambivalence/shame (aOR 0.37 95% CI 0.16-0.90) were associated with lower willingness to use PrEP. Belief that PrEP prevents HIV infection (aOR 27.03 95% CI 9.68-75.46) and self/healthcare provider-initiated HIV testing in the prior 2-years (aOR 1.76 95% CI 1.15-2.68) were associated with willingness to use PrEP. CONCLUSIONS: PrEP uptake among women remains low despite availability and willingness to take PrEP. Eligibility for PrEP varied over time and self-perception of risk was not always congruent with guidelines. Continued efforts are needed to identify those that would benefit from HIV prevention services during routine medical care and develop interventions to increase PrEP prescribing and use.