The factors associated with HIV Pre-Exposure Prophylaxis awareness and use among women aged 40-65 years in SE England: A protocol for the analysis of data from a cross-sectional population survey

Background New HIV diagnoses are increasing among women aged between 40 and 65 years in England. HIV Pre Exposure Prophylaxis (PrEP), the use of antiretrovirals for HIV prevention, is an effective chemoprophylactic strategy, as part of a comprehensive prevention package, for HIV. Granular data on knowledge about, and access to HIV PrEP for women aged between 40 and 65 years, is lacking. This project will be a secondary analysis of a survey of adults in Brighton and Hove, England. It aims to investigate the sociodemographic and sexual behaviour factors that are associated with HIV PrEP awareness and HIV PrEP use in women aged between 40 and 65 years in Brighton and Hove. Methods Health Counts 2024, a cross-sectional, self completion health related survey was conducted in Brighton and Hove in March 2024. The primary outcomes will be HIV PrEP awareness and HIV PrEP use among women aged between 40 and 65 years in Brighton and Hove and will be analysed using descriptive statistics appropriate to distribution. The secondary outcomes will be to determine whether there are associations between sexual behaviours and/ or sociodemographic factors and HIV PrEP awareness and HIV PrEP use for women aged between 40 and 65 years in Brighton and Hove. These will be analysed using descriptive statistics and multifactorial logistic regression models from which odds ratios and 95% confidence intervals will be reported. Ethics and dissemination Ethical approval for the Health Counts survey was obtained from the NHS Health Research Authority (HRA: Ref: 23/LO/0825) and the London Bromley Research Ethics Committee (Ref: 23/LO/0825). Ethical approval for the community enrolment and supported completion pathway was granted by the University of Brighton Cross-School Research Ethics Committee C (2023 to 12553). Findings from this analysis will be disseminated to stakeholders via a scheduled public engagement event (Valuing the voices of women in coastal communities), presentations at conferences and in peer-reviewed journals. Strengths and limitations of this analysis We will be the first to examine HIV PrEP awareness and HIV PrEP use, and sociodemographic and sexual behavioural correlates among women aged between 40 and 65 years in the UK. Health Counts 2024 was extensively developed, piloted, and tested to ensure accessibility and therefore representativeness of results. Lack of HIV PrEP awareness and HIV PreP use among women may limit statistical analysis. Cultural sensitivity and stigma around sexual health behaviour may limit response rates on relevant questions and therefore may limit statistical analysis. Generalisability of the findings may be limited due to known regional differences in population awareness of HIV PrEP.