There are many challenges to accessing PrEP and thus low uptake in the United States. This review (2007–2017) of PrEP implementation identified barriers to PrEP and interventions to match those barriers. The final set of articles (n = 47) included content on cognitive aspects of HIV service providers and individuals at risk for infection, reviews, and case studies. Cognitive barriers and interventions regarding patients and providers included knowledge, attitudes, and beliefs about PrEP. The “purview paradox” was identified as a key barrier—HIV specialists often do not see HIV-negative patients, while primary care physicians, who often see uninfected patients, are not trained to provide PrEP. Healthcare systems barriers included lack of communication about, funding for, and access to PrEP. The intersection between PrEP-stigma, HIV-stigma, transphobia, homophobia, and disparities across gender, racial, and ethnic groups were identified; but few interventions addressed these barriers. We recommend multilevel interventions targeting barriers at multiple socioecological domains.

Partner notification is a widely accepted method whose intent is to limit onwards HIV transmission. With acceleration in the use of new technologies such as text-messaging, e-mail and social network sites, there has been growing interest in utilizing these techniques for “next-generation” HIV partner services (PS). We conducted a systematic review to assess the utilization and effectiveness of these technologies in HIV PS. Our literature search resulted in 1,343 citations, and 8 met our inclusion criteria. We found efforts focused in 3 domains: 1) patient-led anonymous referral online (n=3); 2) provider-led efforts to augment traditional partner notification techniques at public health departments (n=4); 3) a hybrid approach utilizing a website for e-notification available to those with confirmed STI through an STI clinic (n=1). For the provider-led efforts a modest increase in HIV case-finding was noted despite a generally lower rate of successful notification in comparison to traditional PS. The public websites had a high total number of e-notifications sent, but less than 10% of cards were sent for HIV. Furthermore, low awareness of these services was found in surveys amongat-risk target populations. When given a choice, the majority of clients chose to send an e-notification via text versus e-mail. Although successful notification may be lower overall, use of next-generation services provides an avenue to contact those that would previously have been untraceable. Additional research is needed to determine to what extent technology enhanced partner services improves identification of newly infected persons as well as initiating new prevention for HIV negative clients within high-risk networks.

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Methodological limitations in PrEP implementation studies may explain why PrEP implementation is lagging. This methodological review provides a description and critique of the methods used to identify barriers to PrEP implementation in the United States (2007-18). For each selected article, we provide: (1) research questions; (2) measures; (3) design; (4) sample (size and type); and (5) theoretical orientation. Among 79 articles which identified knowledge, attitudes, and behavioral and social/structural barriers to PrEP implementation, 51 (65%) were quantitative; 25 (32%) qualitative; and 3 (4%) were mixedmethods; overall, just one-half described a conceptual approach. About two-thirds of articles were conducted with patients and one-third with healthcare providers. Our review reveals a paucity of longitudinal, mixed-methods, and ethnographic/ observational research and guiding theoretical frameworks; thus, the applicability of results are limited. We recommend that interventions aimed at PrEP implementation address barriers situated at multiple ecological domains, and thus improve PrEP access, uptake, and adherence.

This article presents theoretical and historical analysis of the intersections between social work knowledge and practice and the philosophical tradition of American pragmatism. Reviewing current epistemological debates in social work, as well as the historical dimensions those debates often take on, I argue that engagement with pragmatist thought and the intersecting histories of Progressive Era pragmatists and social reformers can effectively address persistent epistemological and practical concerns in the field of social work. I first analyze contemporary articulations of pragmatism and identify key tenets of pragmatist thought, then go on to present an examination of notable inclusions and exclusions in historical accounts of Progressive Era pragmatists and social reformers. In doing so, I consider connections to historical accounts of the social work profession, as well as the implications of these histories for contemporary pragmatist thought and practice both within and beyond the field of social work.