Improving HIV PrEP uptake by women: A multi-intervention quality improvement project to improve PrEP delivery to women attending a regional specialist sexual health service in England.

OBJECTIVE: Despite accounting for 27% of new HIV diagnoses in 2024, few women in England are prescribed pre-exposure prophylaxis (PrEP). The UK government committed to ending new HIV infections in England by 2030, citing PrEP as a key prevention strategy. Data from a specialist sexual health service (SSHS) in north-west England demonstrated unmet PrEP need among women. We designed a multi-intervention quality improvement project (QIP) to address PrEP offer and uptake by women attending our SSHS. METHODS: A scoping review of the literature identified interventions that increased PrEP delivery to women. An expert group scored interventions for acceptability, practicability, effectiveness, affordability, side-effects and equity (APEASE criteria). High-scoring interventions were implemented in the SSHS for five months from March to July 2024. Eligible women offered and prescribed PrEP were recorded using GUMCAD STI surveillance system. RESULTS: The number of PrEP offers to women increased from 44 during the pre-intervention period to 221 during the intervention period. Average number of offers per month increased from 8.8 to 44.2. PrEP uptake increased from 37 to 79 prescriptions (average number per month 7.4 to 15.8). This reflected offer and uptake rises of 402% and 114% respectively. CONCLUSION: PrEP offers and prescriptions to eligible women attending our SSHS increased during this QIP. Despite limited evidence, we demonstrated that targeting multiple aspects of the PrEP care continuum improves offer and uptake of PrEP by women attending SSHS. Improving PrEP delivery to women is complex, requiring better understanding and support from local and national HIV prevention stakeholders.