Potential Determinants of PrEP Uptake Among Black African and Caribbean Immigrants in New England: A Qualitative Analysis Using the Consolidated Framework for Implementation Research

Pre-exposure prophylaxis (PrEP) uptake remains low among Black immigrant populations in the United States. Limited data exist on determinants of PrEP uptake in this population. Guided by the Consolidated Framework for Implementation Research (CFIR), we explored potential determinants of PrEP uptake among Black immigrants in New England. We conducted in-depth interviews with Black immigrants from Africa and the Caribbean, recruited through a safety-net health care system in New England between December 2024 and August 2025. Eligibility included age ≥ 18 years, residing in Massachusetts, living in the United Sates for ≤ 5 years, PrEP eligible, and willing to discuss HIV and sexual health. Interviews were conducted in participants’ preferred language. Guided by CFIR, we conducted a thematic analysis using NVivo to identify key themes. Of the 20 participants, 70% were female with a mean age of 36.5 (standard deviation [SD] = 7.5) years, 60% were partnered, and 60% were from the Caribbean. The mean US residence was 18.1 months (SD = 10.7). We identified themes across CFIR domains: (1) innovation characteristics (fear of daily medications and side effects), (2) outer setting (cultural/religious barriers, HIV stigma, competing basic needs, and immigration fears), (3) inner setting (health care trust and language barriers), (4) individual characteristics (low perceived HIV risk, PrEP misconceptions), and (5) process (lack of culturally-tailored PrEP information delivery). Black immigrants face unique barriers to PrEP uptake across CFIR domains, including individual beliefs, cultural factors, health care systems, and implementation processes. The results highlight the need for culturally responsive PrEP implementation strategies that target these determinants.