Informing the future of PrEP navigation: Findings from a five-site cluster evaluation

Salabarría-Peña, Yamir; Douglas, Chelsea; Brantley, Meredith; Johnson, Amy K.

doi:10.1016/j.evalprogplan.2021.101999

Cited by 10 publications

(5 citation statements)

References 54 publications

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“…Patient navigation, through peer or professional supports, has been shown to increase engagement in HIV and substance use treatment in other clinical settings and populations, including PrEP-specific navigation [ 47 – 52 ]. This is consistent with our participants’ experiences regarding the value of outreach services supporting PrEP adherence and follow-up in community settings [ 53 ]. Future research could consider assessing the integration of HIV prevention navigators or leveraging already integrated peer staff to enhance PrEP adherence and care coordination through bridge clinics.…”

Section: Discussionsupporting

confidence: 90%

PrEP facilitators and barriers in substance use bridge clinics for women who engage in sex work and who use drugs

Harris,

Weinberger,

O’Brien

et al. 2024

Addict Sci Clin Pract

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Background Women who engage in sex work and use drugs (WSWUD) experience disproportionate HIV risks. Substance use treatment bridge clinics offer an opportunity to increase HIV pre-exposure prophylaxis (PrEP) delivery to WSWUD, but research on best practices is lacking. Therefore, we explored facilitators and barriers to PrEP across the PrEP care continuum in these settings. Methods Bridge clinic and affiliated harm reduction health service providers and WSWUD from Boston were recruited using passive and active outreach between December 2021 and August 2022. Participants were invited to take part in semi-structured phone or in-person interviews to explore HIV prevention and PrEP care experiences overall and within bridge clinic settings. Deductive codes were developed based on HIV risk environment frameworks and the Information-Motivation-Behavioral Skills model and inductive codes were added based on transcript review. Grounded content analysis was used to generate themes organized around the PrEP care continuum. Results The sample included 14 providers and 25 WSWUD. Most WSWUD were aware of PrEP and more than half had initiated PrEP at some point. However, most who initiated PrEP did not report success with daily oral adherence. Providers and WSWUD described facilitators and barriers to PrEP across the steps of the care continuum: Awareness, uptake, adherence, and retention. Facilitators for WSWUD included non-stigmatizing communication with providers, rapid wraparound substance use treatment and HIV services, having a PrEP routine, and service structures to support PrEP adherence. Barriers included low HIV risk perceptions and competing drug use and survival priorities. Provider facilitators included clinical note templates prompting HIV risk assessments and training. Barriers included discomfort discussing sex work risks, competing clinical priorities, and a lack of PrEP adherence infrastructure. Conclusion WSWUD and bridge clinic providers favored integrated HIV prevention and substance use services in harm reduction and bridge clinic settings. Harm reduction and bridge clinic programs played a key role in HIV prevention and PrEP education for WSWUD. Effective behavioral and structural interventions are still needed to improve PrEP adherence for WSWUD.

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Section: Discussionsupporting

confidence: 90%

PrEP facilitators and barriers in substance use bridge clinics for women who engage in sex work and who use drugs

Harris,

Weinberger,

O’Brien

et al. 2024

Addict Sci Clin Pract

View full text Add to dashboard Cite

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“…These assumptions may have underestimated the number of persons served in preceding steps or overestimated the percentages in subsequent steps. Third, some jurisdictions indicated difficulty in reporting linkage [38][39][40][41][42][43][44][45][46][47][48][49][50] Our findings show that PrIDE jurisdictions successfully demonstrated the feasibility of health department-supported programs in expanding PrEP services to MSM and transgender persons at risk for HIV infection. PrIDE jurisdictions exceeded their own targets in the number of persons reached to identify PrEP service needs, referred, and linked to providers, and eventually prescribed PrEP.…”

Section: Limitationsmentioning

confidence: 72%

“…Detailed program-specific lessons from Project PrIDE are included in articles published in a special issue of Evaluation and Program Planning . 38-50…”

Section: Discussionmentioning

confidence: 99%

Expanding PrEP Services for Men Who Have Sex With Men and Transgender Persons Through Health Department Programs: Key Processes and Outcomes From Project PrIDE, 2015-2019

et al. 2022

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Objective: Pre-exposure prophylaxis (PrEP) Implementation, Data to Care, and Evaluation (PrIDE) was a demonstration project implemented by 12 state and local health departments during 2015-2019 to expand PrEP services for men who have sex with men (MSM) and transgender persons at risk for HIV infection. We describe findings from the cross-jurisdictional evaluation of the project. Methods: We analyzed work plans, annual progress reports, and aggregate quantitative program data submitted by funded health departments (n = 12) to identify key activities implemented and summarize key project outcomes. Results: PrIDE jurisdictions implemented multiple health equity–focused activities to expand PrEP services to priority populations, including building program capacity, conducting knowledge and awareness campaigns, providing PrEP support services, and addressing barriers to PrEP use. Overall, PrIDE jurisdictions identified 44 813 persons with PrEP indications. Of these, 74.8% (n = 33 500) were referred and 33.1% (n = 14 821) were linked to PrEP providers, and 25.3% (n = 11 356) were prescribed PrEP. Most persons prescribed PrEP were MSM or transgender persons (87.9%) and persons from racial and ethnic minority groups (65.6%). However, among persons with PrEP indications, non-Hispanic Black/African American persons (14.9% of 18 782) were less likely than non-Hispanic White persons (31.0% of 11 633) to be prescribed PrEP ( z = −33.57; P < .001). Conclusions: PrIDE jurisdictions successfully expanded PrEP services for MSM, transgender persons, and racial and ethnic minority groups by implementing health equity–focused activities that addressed barriers to PrEP services. However, PrEP prescription was generally low, with significant disparities by demographic characteristics. Additional targeted interventions are needed to expand PrEP services, achieve equity in PrEP use, and contribute to ending the HIV epidemic in the United States.

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“…PrEP navigators can bridge the communication gap between patients and providers and address issues of trust, 17,18 especially among marginalized groups of patients. 19 Dedicated personnel or personnel skilled at navigating insurance workflows to access LAI PrEP, such as pharmacy staff, was noted to be crucial for LAI PrEP uptake. Clinics and/or health systems should consider incorporating these roles into their practices to ensure access to LAI PrEP.…”

Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators to Long-Acting Injectable HIV Pre-Exposure Prophylaxis Implementation in Primary Care Since Its Approval in the United States

Keddem,

Thatipelli,

Caceres

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: HIV pre-exposure prophylaxis (PrEP) is a highly effective method to mitigate the HIV epidemic, but uptake of PrEP has been slow and is associated with racial and gender disparities. Oral PrEP requires high levels of adherence to be effective, which may disadvantage certain high-risk groups. The first injectable HIV PrEP, a drug given every two months rather than as a daily pill, was approved by the FDA in December 2021. Setting: A Family Medicine practice in a single health organization in the United States (November 2022 – February 2023) Methods: We conducted interviews with patients and key stakeholders to characterize factors affecting LAI PrEP implementation. Data collection and analysis were guided by the Consolidated Framework for Implementation Research. Interviews were transcribed and analyzed using guided content analysis. Results: Twenty-five patients (n=13) and practice stakeholders (n=12) were interviewed. Overall, stakeholders described a very low uptake of LAI PrEP. Barriers to LAI PrEP included a lack of awareness, insurance and access issues, a lack of streamlined workflow, and a trust in pills over injectables. Facilitators to LAI PrEP implementation included the absence of a pill burden, a culture of shared decision making, and pharmacy support. Conclusion: While uptake has been slow, we have identified several promising strategies for improving rollout and implementation of LAI PrEP. Approaches that can bolster rollout of LAI PrEP include having an interdisciplinary care team that is supported by PrEP navigators and pharmacists and are informed by a patient-centered model of care to increase patient engagement and trust.

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Informing the future of PrEP navigation: Findings from a five-site cluster evaluation

Cited by 10 publications

References 54 publications

PrEP facilitators and barriers in substance use bridge clinics for women who engage in sex work and who use drugs

PrEP facilitators and barriers in substance use bridge clinics for women who engage in sex work and who use drugs

Expanding PrEP Services for Men Who Have Sex With Men and Transgender Persons Through Health Department Programs: Key Processes and Outcomes From Project PrIDE, 2015-2019

Barriers and Facilitators to Long-Acting Injectable HIV Pre-Exposure Prophylaxis Implementation in Primary Care Since Its Approval in the United States

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