Integrating HIV Pre-Exposure Prophylaxis into Family Planning Care: A RE-AIM Framework Evaluation

Abstract

We aimed to systematically evaluate the feasibility of integrating HIV prevention services, including preexposure prophylaxis (PrEP), into a family planning setting in a high-prevalence community. We used the RE-AIM Framework (Reach, Efficacy, Adoption, Implementation, Maintenance) to evaluate the integration of HIV prevention services into a family planning clinic over 6 months. Before the integration, PrEP was not offered. We implemented a staff training program on HIV PrEP. We determined the proportion of women presenting to the clinic who were screened, eligible for, and initiated PrEP through chart review. We assessed staff comfort with PrEP pre-and post-integration. We compared planned and actual implementation, interviewed staff to determine barriers and facilitators, and tracked systems adaptations. We assessed maintenance of PrEP after the study concluded. There were 640 clinical encounters for 515 patients; the rate of HIV counseling and PrEP screening was 50%. The rate was 10% in month 1 and peaked to 65% in month 3. Nearly all screened patients were eligible for PrEP (98.4%) and 15 patients (6%) initiated PrEP. Staff knowledge and comfort discussing PrEP improved after education. Facilitators included partnering with local experts, continuing education, clinical tools for providers, and patient education materials. Barriers included competing priorities during clinical encounters, limited woman-centered patient education materials, and insurance-related barriers. Embedding HIV prevention services in the family planning setting was feasible in this pilot. The proportion of women screened for PrEP rapidly increased. In this high HIV prevalence community, nearly all screened women were eligible and 6% initiated PrEP.

Toward Greater Pre-exposure Prophylaxis Equity: Increasing Provision and Uptake for Black and Hispanic/Latino Individuals in the U.S.

“…78 One family planning clinic serving predominantly Black women implemented a pilot staff training program to increase PrEP provision, including same-day PrEP, and reported that HIV counseling and PrEP screening increased from 10% at 1 month to >50% at 6 months. 79 Another intervention currently under study trains PrEP clinical change teams at Southern Title X clinics to lead PrEP implementation for women within their family planning services. 80 A complementary strategy to expand PrEP services is to increase the number and type of healthcare professionals who know how to prescribe PrEP.…”

Women Trust Their OBGYNs to Provide Preexposure Prophylaxis: An Opportunity for HIV Prevention

“…But for some OBGYNs, the ability to add PrEP provision to routine care may seem challenging for OBGYNs that already face challenges with providing multiple components of care with significant time constraints ( 10 ). Frameworks such as RE_AIM (Reach, Efficiency, Adoption, Implementation, Maintenance) have been used to successfully integrate HIV Prevention services despite known barriers like time constraints and insurance barriers ( 9 ).…”

“…Despite some local efforts to promote PrEP implementation in diverse practice settings, most clinicians have not provided PrEP ( 7 , 9 ). Clinicians identified need for education around PrEP provision and some raise concern that addition of counseling and provision of PrEP to already busy clinical environments is challenging ( 10 , 11 ).…”

Evaluation of an HIV Pre-Exposure Prophylaxis Referral System: From Sexual Health Center to Federally Qualified Health Center Pre-Exposure Prophylaxis Clinic

“…19 In addition, our group is working with the LDH to enhance PrEP awareness and uptake among women, following the efforts of other investigators in working with women's health providers and family planning clinics. [20][21][22][23][24] Finally, Louisiana is fortunate to have expanded Medicaid, and thus may have fewer barriers to PrEP access relative to non-Medicaid expansion states. 25 In response to the findings presented in this study, our team is currently investigating the use of Rapid PrEP initiation at the SHC.…”