SynthesisBMC public health2026
Barriers and facilitators to PrEP knowledge, acceptability, uptake, and adherence among criminal-justice involved cisgender women: a systematic review.
Synthesis in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveCisgender women involved in the U.S. criminal justice system (CJI) experience heightened HIV vulnerability due to intersecting structural risks such as substance use, unstable housing, intimate partner violence, and limited healthcare access. Despite the effectiveness of pre-exposure prophylaxis (PrEP), uptake remains low in this population. This systematic review synthesized evidence on barriers and facilitators influencing PrEP knowledge, acceptability, initiation, uptake, and adherence among CJI cisgender women and examined how racial and ethnic disparities were addressed within the literature.
designSystematic review of empirical studies examining PrEP-related outcomes among cisgender women involved in the U.S. criminal justice system.
methodsPubMed, PsycINFO, Embase, Web of Science, CINAHL, Google Scholar, PAIS, EBSCO, and Criminal Justice Abstracts were searched for studies published between January 2013 and July 2025. Screening and study selection followed PRISMA 2020 guidelines. Data extraction and methodological quality appraisal were conducted using the Mixed Methods Appraisal Tool (MMAT). Eligible studies examined one or more PrEP-related outcomes, including knowledge, acceptability, initiation, uptake, adherence, or barriers and facilitators to engagement.
resultsOut of 1,728 records identified, 568 duplicates were removed, leaving 1,160 unique records for screening. Following title/abstract review, 86 full-text articles were assessed for eligibility, and 12 studies met inclusion criteria (qualitative, n = 8; quantitative, n = 3; mixed-methods, n = 1). Findings demonstrated consistently low PrEP knowledge among CJI cisgender women, particularly among Black and Latina women, due to limited targeted education, misinformation, and gaps in provider communication. Acceptability of PrEP was generally high when information was delivered through trusted healthcare providers, peer networks, or community-based programs. However, structural barriers, including stigma, healthcare mistrust, fragmented correctional healthcare systems, unstable housing, insurance discontinuity, and limited post-release care coordination, substantially restricted PrEP uptake and adherence. Facilitators included peer support, transitional care programs, community outreach, culturally tailored education, and access to public insurance and integrated healthcare services. Few studies explicitly centered racial and ethnic inequities despite the disproportionate HIV burden experienced by Black women within criminal justice settings.
conclusionCJI cisgender women remain substantially underserved within the U.S. PrEP implementation landscape. Findings highlight the importance of multilevel, equity-informed interventions that address structural barriers, strengthen continuity of care across incarceration and reentry settings, and incorporate culturally responsive, peer-driven, and trauma-informed approaches. Greater attention to structural, racial and ethnic disparities in future research and intervention design is essential to advancing HIV prevention equity among CJI cisgender women.
trial registrationThis review was registered in PROSPERO (CRD420251086367).
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