Date of Award

January 2026

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Trace Kershaw

Abstract

Background: Women bear a disproportionate burden of the global Human Immunodeficiency Virus (HIV) epidemic yet are underrepresented in HIV prevention research. Intimate partner violence (IPV) is an established driver of HIV vulnerability. No meta-analysis has examined how experience with IPV shapes women's engagement across the pre-exposure prophylaxis (PrEP) care continuum. This study aimed to (1) synthesize evidence on PrEP continuum engagement among women who experience IPV, and (2) examine whether engagement differs by IPV subtype.Methods: PubMed and CINAHL were systematically searched for studies that reported quantitative outcomes on the PrEP care continuum among women who experienced IPV. Pooled effect sizes were estimated for outcomes with ≥2 studies through a random effects model. Evidence quality was assessed through GRADE, and risk of bias was evaluated using a modified Newcastle-Ottawa Scale. Results: Sixteen studies consisting of 15,424 participants were included. Studies were mainly conducted in the United States (n=10) and sub-Saharan Africa (n=6). Women who experienced IPV had significantly higher odds of HIV worry (OR: 2.82; 95% CI: 1.19-6.72). Statistically significant associations were not observed for PrEP acceptability/willingness (OR: 1.04; 95% CI: 0.71-1.52) or uptake/initiation (OR: 1.95; 95% CI: 0.67-5.70). Through GRADE, all pooled estimates were determined to have “low” to “very low” quality of evidence. Subtype-specific exploration revealed no distinct pattern across physical, sexual, or psychological IPV, though most estimates were underpowered. Conclusion: Despite heightened HIV worry, women who experience IPV do not have significantly higher levels of engagement at later stages of the PrEP care continuum, suggesting perceived vulnerability may not translate into further preventive action. Findings are limited due to a small number of publications, small sample sizes, a lack of geographical diversity and substantial heterogeneity in how IPV and PrEP outcomes are measured. Future research should prioritize this population across diverse geographic contexts and address the context-dependent constraints women face in engaging with the PrEP care continuum.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 09/16/2027

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