Pre-exposure prophylaxis awareness, interest, and modality preferences to prevent HIV among cisgender women in the Dominican Republic and the United States

Significant inequities in HIV incidence and prevalence exist among cisgender women (hereafter women), including a disproportionate burden of the epidemic among Black women in the United States and female sex workers globally. Women have limited awareness of and access to pre–exposure prophylaxis (PrEP) for HIV pharmacoprevention. We explored PrEP awareness, interest, and modality preferences [daily oral vs. long–acting injectable (LAI) PrEP] in Santo Domingo, Dominican Republic (DR) and Washington, DC (DC) in the United States through in–depth interviews (IDIs) with women (N = 40) and healthcare providers (HCPs; N = 20) in 2021–2022 and surveys of women (N = 602) in 2022–2023. Thematic analysis andmultivariate regression were utilized. Across settings, women were aged ≥18 years and HIV–negative; most were Black or multiracial, single, in their 30s, with >1 child. In IDIs, women characterized PrEP as an empowerment tool and welcomed modality options; HCPs across sites relayed a lack of comfort and preparation to address the unique needs of women and discuss LAI PrEP. In surveys, women reported low PrEP awareness and use: 29% (DC) and 6% (DR) had heard of daily oral PrEP, <6% had heard of LAI PrEP across sites, and 3% (DC) and 1% (DR) had ever used PrEP. Strong interest in taking PrEP varied (DC, 5%; DR, 80%). Modality preferences were similar, with most preferring LAI vs. daily oral PrEP (DC, 73%; DR, 71%). Across sites, preference for LAI PrEP was inversely associated with concern for injection pain/tenderness. In DC, LAI preference was associated with a higher score on a PrEP optimization/ considerations scale. In the DR, LAI preference was associated with injectable medication/contraception experience and alcohol use and inversely associated with PrEP stigma and partner violence. Diverse groups of women have shared and unique drivers of PrEP modality preferences which should be considered when developing and tailoring multi–level interventions to promote PrEP awareness and uptake among women. These interventions should address social determinants and side effects and include HCP training and tools that promote shared decision–making.