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Examining the Factors Affecting PrEP Implementation Within Community-Based HIV Testing Sites in Florida: A Mixed Methods Study Applying the Consolidated Framework for Implementation Research

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Abstract

HIV testing/counseling is a critical point during which non-clinical staff could intervene, discuss and/or refer clients for pre-exposure prophylaxis (PrEP). This analysis investigated the contextual factors affecting PrEP implementation within HIV testing sites. Two generalized linear mixed models were conducted to estimate PrEP implementation as a function of constructs from the Consolidated Framework for Implementation Research (CFIR). Qualitative interviews were analyzed thematically. Data integration occurred via joint analysis and triangulation. Constructs from the CFIR domain Characteristics of Individuals did not predict PrEP implementation when controlling for demographic characteristics; qualitative data signaled divergent findings in PrEP knowledge. Within the CFIR domains Inner and Outer Settings, relevant priority and available resources predicted PrEP implementation; qualitative data confirmed the importance of available resources and provided insight into the impact of cosmopolitanism and leadership. Addressing the contextual factors that affect PrEP implementation may help HIV testing staff to better implement PrEP programs.

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References

  1. Spinner CD, Boesecke C, Zink A, Jessen H, Stellbrink HJ, Rockstroh JK, et al. HIV pre-exposure prophylaxis (PrEP): a review of current knowledge of oral systemic HIV PrEP in humans. Infection. 2016;44(2):151–8.

    Article  Google Scholar 

  2. Anderson PL, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012;4(151):151ra25.

    Article  Google Scholar 

  3. CDC. PrEP 2016. http://www.cdc.gov/hiv/workplace/education/prep.html. Accessed 5 Oct 2016.

  4. World Health Organization. Policy brief: pre-exposure prophylaxis (PrEP): WHO expands recommendation on oral pre-exposure prophylaxis of HIV infection (PrEP). Geneva, Switzerland: World Health Organization; 2015. p. 2. Report No. WHO/HIV/2015.48.

  5. World Health Organization. Guidance on oral pre-exposure prophylaxis (PrEP) for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV: recommendations for use in the context of demonstration projects. Geneva, Switzerland: World Health Organization; 2012. p.19. ISBN: 978 92 4 150388 4.  

  6. World Health Organization. Guidance on couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples: recommendations for a public health approach. Geneva, Switzerland: World Health Organization; 2012. p. 79. ISBN 978 92 4 150197 2.  

  7. CDC. Pre-Exposure Prophylaxis (PrEP) 2014. http://www.cdc.gov/hiv/prevention/research/prep/. Accessed 9 March 2015.

  8. The White House Office of National AIDS Policy. National HIV/AIDS strategy for the United States: Updated to 2020. In: Policy OoNA, editor. Washington, D.C.2015.

  9. U.S. Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States –2014 clinical providers’ Supplement 2014.

  10. Services USDoHH. Ending the HIV epidemic 2019. https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/hiv-in-america. Accessed 14 Jan 2020

  11. Krakower DS, Mayer KH. The role of healthcare providers in the roll-out of PrEP. Curr Opin HIV AIDS. 2016;11(1):41.

    Article  Google Scholar 

  12. Smith DK, Maier E, Betts J, Gray S, Kolodziejski B, Hoover KW. What community-based HIV prevention organizations say about their role in biomedical HIV prevention. AIDS Educ Prev. 2016;28(5):426–39.

    Article  Google Scholar 

  13. Krakower DS, Jain S, Mayer KH. Antiretrovirals for primary HIV prevention: the current status of pre- and post-exposure prophylaxis. Curr HIV/AIDS Rep. 2015;12(1):127–38.

    Article  Google Scholar 

  14. Krakower DS, Mayer KH. The role of healthcare providers in the roll out of preexposure prophylaxis. Curr Opin HIV AIDS. 2016;11(1):41–8.

    Article  Google Scholar 

  15. Krakower D, Mayer KH. Engaging healthcare providers to implement HIV pre-exposure prophylaxis. Curr Opin HIV AIDS. 2012;7(6):593–9.

    Article  Google Scholar 

  16. Mayer KH, Chan PA, Patel RR, Flash CA, Krakower DS. Evolving models and ongoing challenges for HIV preexposure prophylaxis Implementation in the United States. J Acquir Immune Defic Syndr. 2018;77(2):119–27.

    Article  Google Scholar 

  17. Smith DK, Dearing JW, Sanchez T, Goldschmidt RH. Introducing wicked issues for HIV pre-exposure prophylaxis implementation in the U.S. Am J Prev Med. 2013;44(1 Suppl 2):S59-62.

    Article  Google Scholar 

  18. Underhill K, Morrow KM, Colleran CM, Holcomb R, Operario D, Calabrese SK, et al. Access to healthcare, HIV/STI testing, and preferred pre-exposure prophylaxis providers among men who have sex with men and men who engage in street-based sex work in the US. PLoS ONE. 2014;9(11):e112425.

    Article  Google Scholar 

  19. Underhill K, Operario D, Mimiaga MJ, Skeer MR, Mayer KH. Implementation science of pre-exposure prophylaxis: preparing for public use. Curr HIV/AIDS Rep. 2010;7(4):210–9.

    Article  Google Scholar 

  20. Underhill K, Operario D, Skeer M, Mimiaga M, Mayer K. Packaging PrEP to prevent HIV: an integrated framework to plan for pre-exposure prophylaxis implementation in clinical practice. J Acquir Immune Defic Syndr. 2010;55(1):8–13.

    Article  Google Scholar 

  21. FDOH. DH1628 Laboratory request form 2012.

  22. Parsons JT, John SA, Whitfield THF, Cienfuegos-Szalay J, Grov C. HIV/STI counseling and testing services received by gay and bisexual men using pre-exposure prophylaxis (PrEP) at their last PrEP care visit. Sex Transm Dis. 2018;45:798.

    Article  Google Scholar 

  23. Hevey MA, Walsh JL, Petroll AE. PrEP Continuation, HIV and STI testing rates, and delivery of preventive care in a clinic-based cohort. AIDS Educ Prev. 2018;30(5):393–405.

    Article  Google Scholar 

  24. Wilton J, Kain T, Fowler S, Hart TA, Grennan T, Maxwell J, et al. Use of an HIV-risk screening tool to identify optimal candidates for PrEP scale-up among men who have sex with men in Toronto, Canada: disconnect between objective and subjective HIV risk. J Int AIDS Soc. 2016;19(1):20777.

    Article  Google Scholar 

  25. Kwan TH, Lee SS. Predictors of HIV testing and their influence on PrEP acceptance in men who have sex with men: a cross-sectional study. AIDS Behav. 2018;22(4):1150–7.

    Article  Google Scholar 

  26. Flash CA, Adegboyega OO, Yu X, Avalos C, Johnson S, Mayer KH, et al. Correlates of linkage to HIV preexposure prophylaxis among HIV-testing clients. JAIDS J Acquir Immune Defic Syndr. 2018;77(4):365–72.

    Article  Google Scholar 

  27. Hammack PL, Meyer IH, Krueger EA, Lightfoot M, Frost DM. HIV testing and pre-exposure prophylaxis (PrEP) use, familiarity, and attitudes among gay and bisexual men in the United States: a national probability sample of three birth cohorts. PLoS ONE. 2018;13(9):e0202806.

    Article  Google Scholar 

  28. Turner D, Lockhart E, Wang W, Shore R, Daley EM, Marhefka SL. PrEP implementation behaviors of community-based HIV testing staff: a mixed methods approach using latent class analysis. J Acquir Immune Defic Syndr. 2020;83:467.

    Article  Google Scholar 

  29. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.

    Article  Google Scholar 

  30. Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. Thousand Oaks: Sage publications; 2013.

    Google Scholar 

  31. Qualtrics. Provo, Utah, USA2017.

  32. Dillman DA. Mail and internet surveys: the tailored design method—2007 update with new internet, visual, and mixed-mode guide. New York: Wiley; 2011.

    Google Scholar 

  33. Blumenthal J, Jain S, Krakower D, Sun X, Young J, Mayer K, et al. Knowledge is Power! increased provider knowledge scores regarding pre-exposure prophylaxis (PrEP) are associated with higher rates of PrEP prescription and future intent to prescribe PrEP. AIDS Behav. 2015;19(5):802–10.

    Article  Google Scholar 

  34. Walsh JL, Petroll AE. Using the information-motivation-behavioral skills model to predict discussion and prescription of pre-exposure propohylaxis among primary care providers. American Public Health Association 144th Annual Meeting and Expo; November 2, 2016; Denver, CO2016.

  35. Helfrich CD, Li Y-F, Sharp ND, Sales AE. Organizational readiness to change assessment (ORCA): development of an instrument based on the promoting action on research in health services (PARIHS) framework. Implement Sci. 2009;4(38):38.

    Article  Google Scholar 

  36. Damschroder. CFIR Technical Assistance Website 2016. http://cfirguide.org/. Accessed 29 April 2015

  37. Gustafson DH, Sainfort F, Eichler M, Adams L, Bisognano M, Steudel H. Developing and testing a model to predict outcomes of organizational change. Health Serv Res. 2003;38(2):751–76.

    Article  Google Scholar 

  38. SPSS I. IBM SPSS statistics for Windows, version 20.0. New York: IBM Corp. 2011.

  39. Heck RH, Thomas S, Tabata L. Multilevel modeling of categorical outcomes using IBM SPSS: Routledge; 2013.

  40. Kuckartz U. MAXQDA: Qualitative data analysis. Berlin: VERBI software; 2007.

    Google Scholar 

  41. Guest G, MacQueen KM, Namey EE. Applied thematic analysis. Thousand Oaks: Sage; 2011.

    Google Scholar 

  42. Creswell JW, Klassen AC, Plano Clark VL, Smith KC. Best practices for mixed methods research in the health sciences. Bethesda, MD: National Institutes of Health; 2011. p. 10.

    Google Scholar 

  43. Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs—principles and practices. Health Serv Res. 2013;48(6pt2):2134–56.

    Article  Google Scholar 

  44. Tellalian D, Maznavi K, Bredeek UF, Hardy WD. Pre-exposure prophylaxis (PrEP) for HIV infection: results of a survey of HIV healthcare providers evaluating their knowledge, attitudes, and prescribing practices. AIDS Patient Care STDS. 2013;27(10):553–9.

    Article  Google Scholar 

  45. Calabrese SK, Magnus M, Mayer KH, Krakower DS, Eldahan AI, Gaston Hawkins LA, et al. Putting PrEP into practice: lessons learned from early-adopting US providers’ firsthand experiences providing HIV pre-exposure prophylaxis and associated care. PLoS ONE. 2016;11(6):e0157324.

    Article  Google Scholar 

  46. White JM, Mimiaga MJ, Krakower DS, Mayer KH. Evolution of Massachusetts physician attitudes, knowledge, and experience regarding the use of antiretrovirals for HIV prevention. AIDS Patient Care STDS. 2012;26(7):395–405.

    Article  Google Scholar 

  47. FDOH. The basics of HIV/AIDS counseling, testing, and linkage course HIV/AIDS 500 & HIV/AIDS 501 2018. http://www.floridahealth.gov/diseases-and-conditions/aids/prevention/_documents/Counseling_testing/500-501-Participant-Manual-2018.pdf. Accessed 20 Nov 2018

  48. FDOH. Epidemiology of HIV infection trends in florida diagnosed through 2014: Florida Department of Health; 2016. http://www.floridahealth.gov/%5C/diseases-and-conditions/aids/surveillance/_documents/hiv-aids-slide-sets/2014/state_trends_2014b.pdf. Accessed 20 Sept 2016.

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Acknowledgements

We would like to acknowledge the participants for their service to our communities and for taking part in this research. This study was funded, in part, via the USF College of Public Health Research Award and the USF Graduate School Dissertation Completion Fellowship Award. Further data analyses and preparation reported in this paper were completed by the primary author during a postdoctoral fellowship supported by the National Institute of Mental Health under award number T32MH020031 (PI: Kershaw). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Yale AIDS Prevention Training Program (Y-APT), Center for Interdisciplinary Research on AIDS (CIRA), Yale University, 135 College St. Suite 200, New Haven, CT, 06510, USA

    DeAnne Turner

  2. College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, Tampa, FL, 33612, USA

    Elizabeth Lockhart, Ellen Daley & Stephanie L. Marhefka

  3. Centre for Addiction and Mental Health (CAMH), 1001 Queen St W, West Wing 190, Toronto, ON, M6J 1H4, Canada

    Wei Wang

  4. Midway Specialty Care Center, a 501 (c)3 organization, 2608 NE 16th Avenue, Wilton Manors, FL, 33334, USA

    Robert Shore

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  1. DeAnne Turner
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Correspondence to DeAnne Turner.

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Turner, D., Lockhart, E., Wang, W. et al. Examining the Factors Affecting PrEP Implementation Within Community-Based HIV Testing Sites in Florida: A Mixed Methods Study Applying the Consolidated Framework for Implementation Research. AIDS Behav 25, 2240–2251 (2021). https://doi.org/10.1007/s10461-020-03152-1

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