Date of Award

January 2026

Document Type

Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Joanne Iennaco

Second Advisor

Christine Rodriguez

Abstract

Although HIV transmission has declined nationally with increased PrEP use, Black cisgender women continue to experience a disproportionate burden alongside persistently low PrEP uptake. A literature review identified five contributing factors: medical mistrust, non-inclusive PrEP advertising, low self-perceived HIV risk, provider-related barriers, and under-utilization of advocacy and empowerment. This DNP project developed, implemented, and evaluated the FEMMEPrEP toolkit (Fostering Empowerment, Motivation, and Meaningful Education for PrEP) for primary care providers at a federally qualified health center to improve HIV risk awareness and PrEP uptake among heterosexual Black ciswomen in a high-incidence urban setting. Using a mixed-methods quality improvement approach, the 10-week implementation included provider education, a prescriber PrEP pocket guide, tailored patient education materials, and an adapted HIV Risk Self-Assessment Tool integrated into clinical workflows and administered during triage to guide provider-led discussions and counseling. Staff knowledge and self-efficacy improved, with statistically significant gains among medical assistants and increases among providers. Among 162 patients, 26.5% were identified as moderate-to-high risk for HIV; all demonstrated increased self-perceived risk, and overall awareness increased in 89.5%. Higher risk scores were strongly associated with interest and discussions about PrEP, as well as prescribing (p < .001), resulting in 10 PrEP initiations. Behavioral differences between risk groups supported the tool’s validity. High acceptability and appropriateness were observed, though feasibility varied due to workflow constraints, highlighting the need for system-level integration. These findings support scalability and advancing health equity in similar settings.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 10/06/2027

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