Primary Care and Pre-exposure Prophylaxis Services in Publicly Funded Family Planning Clinics in the Southern United States

J Gen Intern Med. 2021 Oct;36(10):2958-2965. doi: 10.1007/s11606-020-06509-3. Epub 2021 Jan 14.


Background: HIV pre-exposure prophylaxis (PrEP) is underutilized by US women. Cost and resource concerns are barriers to PrEP delivery in settings that see men. Family planning clinics may be ideal PrEP delivery settings for women, but as they are not uniform in their clinical services, cost and resource concerns may vary.

Objective: We examined factors that influence perceptions of costs and resources related to PrEP delivery in Title X-funded family planning clinics in Southern states, which overlaps with high HIV-burden areas.

Design: We conducted a web-based survey among a convenience sample of clinicians and administrators of Title X clinics across 18 Southern states (DHHS regions III, IV, VI). We compared cost- and resource-related survey items and other clinic- and county-level variables between clinics by whether their clinics also provided other primary care services. We analyzed interviews for cost and resource themes.

Participants: Title X clinic staff in the South.

Key results: Among 283 unique clinics, a greater proportion of clinics that also provided primary care currently provided PrEP compared with those that did not provide primary care (27.8% vs. 18.3%, p = 0.06), but this difference was not statistically significant. Among 414 respondents in clinics that were not providing PrEP, those in clinics with primary care services were more likely to respond that they had the necessary financial resources (p < 0.01) and staffing (p < 0.01) for PrEP implementation compared to those without primary care services. In interviews, respondents differed on concerns about costs of labs and staffing based on whether their clinic had concomitant primary care services or not.

Conclusions: Among publicly funded Southern family planning clinics, current PrEP provision was higher among clinics with concomitant primary care. Among clinics not providing PrEP, those with concomitant primary care services have lower perceived cost and resource barriers and therefore may be optimal for expanding PrEP among women.

Keywords: HIV; PrEP; Title X; family planning; women’s health.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Anti-HIV Agents* / therapeutic use
  • Family Planning Services
  • Female
  • HIV Infections* / drug therapy
  • HIV Infections* / prevention & control
  • Humans
  • Male
  • Pre-Exposure Prophylaxis*
  • Primary Health Care
  • United States / epidemiology


  • Anti-HIV Agents