Pre-Exposure Prophylaxis Integration into Family Planning Services at Title X Clinics in the Southeastern United States: A Geographically-Targeted Mixed Methods Study (Phase 1 ATN 155)

Sales, jessica; Escoffery, Cam; Hussen, Sophia A.; Haddad, Lisa; Phillips, Ashley; Filipowicz, Teresa; Sanchez, Maria; McCumber, Micah; Rupp, Betty; Kwiatkowski, Evan; Psioda, Matthew A.; Sheth, Anandi N.

doi:10.2196/12774

Cited by 15 publications

(17 citation statements)

References 29 publications

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“…A comprehensive overview of the study’s protocol, methods, and measures has been published elsewhere [ 36 ]. In brief, quantitative surveys took place online with the assistance of the National Clinical Training Center for Family Planning (NCTCFP).…”

Section: Methodsmentioning

confidence: 99%

Exploring the heterogeneity of factors that may influence implementation of PrEP in family planning clinics: a latent profile analysis

Piper

Haardörfer

Escoffery

et al. 2021

Implement Sci Commun

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Background Title X-funded family planning clinics have been identified as optimal sites for delivery of pre-exposure prophylaxis (PrEP) for HIV prevention. However, PrEP has not been widely integrated into family planning services, especially in the Southern US, and data suggest there may be significant implementation challenges in this setting. Because Title X clinics vary greatly in provider-, organizational-, and systems-level characteristics, there is likely variation in capacity to implement PrEP across clinics. Methods We conducted a survey from February to June 2018 among providers and administrators of non-PrEP-providing Title X-funded clinics across 18 southern states. Survey items were designed using the Consolidated Framework for Implementation Research (CFIR) to assess constructs relevant to PrEP implementation. To explore the heterogeneity of CFIR-related implementation determinants and identify distinct sub-groups of Title X clinics, a latent profile analysis was conducted using nine CFIR constructs: complexity, relative advantage, cost, attitudes, implementation climate, compatibility, leadership engagement, available resources, and cosmopolitanism. We then conducted a multi-level analysis (accounting for nesting of participants within clinics) to test whether group membership was associated with readiness for implementation of PrEP, controlling for key sociodemographic characteristics. Results Four hundred and fourteen healthcare providers/administrators from 227 non-PrEP-providing Title X clinics participated in the study. We identified six sub-groups of clinics that each had distinct patterns of PrEP implementation determinants. Clinic sub-groups included “Highest Capacity for Implementation”, “Favorable Conditions for Implementation”, “Mixed Implementation Context”, “Neutral Implementation Context”, “Incompatible Setting for Implementation”, and “Resource-Strained Setting”. Group membership was related to numerous provider-level (i.e., ability to prescribe medication) and clinic-level (i.e., provision of primary care) characteristics. In comparison to the “Neutral” group (which held neutral perceptions across the implementation determinants), the “Highest Capacity” and “Favorable Conditions” groups had significantly higher levels of implementation readiness, and the “Resource-Strained” group had a significantly lower level of implementation readiness. Conclusions Latent profile analyses can help researchers understand how implementation readiness varies across healthcare settings, promoting tailoring of implementation strategies to unique contexts.

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Section: Methodsmentioning

confidence: 99%

Exploring the heterogeneity of factors that may influence implementation of PrEP in family planning clinics: a latent profile analysis

Piper

Haardörfer

Escoffery

et al. 2021

Implement Sci Commun

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“…The EPIS framework [ 32 ] is a phased, multilevel (ie, clinic and provider and staff-level) approach to conceptualizing implementation research that provides both structure and a process to implementation across 4 distinct stages. Exploration , the first stage, was assessed in the first phase of this study [ 31 ]. The next step, preparation , involves bringing together relevant stakeholders in a planning process to support effective implementation and includes developing a proposed plan to address barriers (eg, through clinic-wide PrEP trainings and capacity building with local PrEP technical assistance providers).…”

Section: Methodsmentioning

confidence: 99%

“…Quantitative and qualitative data will be collected for staff participants at three time points (approximately annually). Quantitative data will be collected via a web-based survey [ 31 ], taking approximately 20-30 min to complete. For the staff survey, the study staff will distribute the survey link via clinic email addresses.…”

Section: Methodsmentioning

confidence: 99%

“…The combined findings and resulting tools and trainings will be valuable for PrEP integration in Title X–funded or similarly structured FP clinics and to inform future interventions to optimize PrEP delivery for AYAW. Phase 2 of Planning4PrEP was directly guided by phase 1 of the study; review phase 1 protocol paper for complete details [ 31 ]. In this paper, we describe only the research protocol for the phase 2 study.…”

Section: Introductionmentioning

confidence: 99%

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Pre-Exposure Prophylaxis Integration Into Family Planning Services at Title X Clinics in the Southeastern United States: Protocol for a Mixed Methods Hybrid Type I Effectiveness Implementation Study (Phase 2 ATN 155)

et al. 2020

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Background Adolescent and young adult women (AYAW), particularly racial and ethnic minorities, in the Southern United States are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is an effective, scalable, individual-controlled HIV prevention strategy that is grossly underutilized among women of all ages and requires innovative delivery approaches to optimize its benefit. Anchoring PrEP delivery to family planning (FP) services that AYAW already trust, access routinely, and deem useful for their sexual health may offer an ideal opportunity to reach women at risk for HIV and to enhance their PrEP uptake and adherence. However, PrEP has not been widely integrated into FP services, including Title X–funded FP clinics that provide safety net sources of care for AYAW. To overcome potential implementation challenges for AYAW, Title X clinics in the Southern United States are uniquely positioned to be focal sites for conceptually informed and thoroughly evaluated PrEP implementation science studies. Objective The objective of this study is two-fold: to evaluate multilevel factors associated with the level of PrEP adoption and implementation (eg, PrEP screening, counseling, and prescription) within and across 3 FP clinics and to evaluate PrEP uptake, persistence, and adherence among female patients in these clinics over a 6-month follow-up period. Methods Phase 2 of Planning4PrEP (Adolescent Medicine Trials Network for HIV/AIDS Interventions 155) is a mixed methods hybrid type 1 effectiveness implementation study to be conducted in three clinics in Metro Atlanta, Georgia, United States. Guided by the Exploration, Preparation, Implementation, and Sustainment framework, this study will prepare clinics for PrEP integration via clinic-wide trainings and technical assistance and will develop clinic-specific PrEP implementation plans. We will monitor and evaluate PrEP implementation as well as female patient PrEP uptake, persistence, and adherence over a 6-month follow-up period. Results Phase 2 of Planning4PrEP research activities began in February 2018 and are ongoing. Qualitative data analysis is scheduled to begin in Fall 2020. Conclusions This study seeks to evaluate factors associated with the level of PrEP adoption and implementation (eg, PrEP screening, counseling, and prescription) within and across 3 FP clinics following training and implementation planning and to evaluate PrEP uptake, persistence, and adherence among female patients over a 6-month follow-up period. This will guide future strategies to support PrEP integration in Title X–funded clinics across the Southern United States. Trial Registration ClinicalTrials.gov NCT04097834; https://clinicaltrials.gov/ct2/show/NCT04097834 International Registered Report Identifier (IRRID) DERR1-10.2196/18784

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“…The survey took approximately 15-25 minutes to complete, and participants received a $30 incentive. All procedures and recruitment methods have been described previously (33). Institutional Review Boards from Emory University and University of North Carolina approved the study protocol prior to data collection (See Additional File 1 for STROBE checklist).…”

Section: Methodsmentioning

confidence: 99%

Exploring the Heterogeneity of Factors that may Influence Implementation of PrEP in Family Planning Clinics: A Latent Profile Analysis

Piper

Haardörfer

Escoffery

et al. 2020

Preprint

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Background: Title X-funded family planning clinics have been identified as optimal sites for delivery of pre-exposure prophylaxis (PrEP) for HIV prevention. However, PrEP has not been widely integrated into family planning services, especially in the Southern U.S., and data suggest there may be significant implementation challenges in this setting. Because Title X clinics vary greatly in provider-, organizational-, and systems-level characteristics, there is likely variation in capacity to implement PrEP across clinics. Methods: We conducted a survey from February-June 2018 among providers and administrators of non-PrEP providing Title X-funded clinics across 18 southern states. Survey items were designed using the Consolidated Framework for Implementation Research (CFIR) to assess constructs relevant to PrEP implementation. To explore the heterogeneity of CFIR-related determinants and identify distinct sub-groups of Title X clinics, a latent profile analysis was conducted using nine CFIR constructs: complexity, relative advantage, cost, attitudes, implementation climate, compatibility, leadership engagement, available resources, and cosmopolitanism. We then conducted a multi-level analysis (accounting for nesting of participants within clinics) to test whether group membership was associated with readiness for implementation of PrEP, controlling for key sociodemographic characteristics. Results: 414 healthcare providers/administrators from 227 non-PrEP providing Title X clinics participated in the study. We identified six sub-groups of clinics that each had distinct patterns of perceptions across the CFIR-related determinants. Clinic sub-groups included: “High Capacity”, “Optimistic”, “Advantageous”, “Moderate”, “Incompatible”, and “Resource Constrained”. Group membership was related to numerous provider-level (i.e., ability to prescribe medication), clinic-level (i.e., provision of primary care), and community-level characteristics (i.e., county-level HIV prevalence). In comparison to the “Moderate” group (which held neutral perceptions across the CFIR constructs), the “High Capacity” and “Optimistic” groups had significantly higher levels of implementation readiness; and the “Resource Constrained group had a significantly lower level of implementation readiness.Conclusions: Latent profile analyses can help researchers understand how context-specific implementation determinants vary across individuals and settings (such as clinics), allowing implementation planning to be tailored to the specific needs of each segment of the population.

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Pre-Exposure Prophylaxis Integration into Family Planning Services at Title X Clinics in the Southeastern United States: A Geographically-Targeted Mixed Methods Study (Phase 1 ATN 155)

Cited by 15 publications

References 29 publications

Exploring the heterogeneity of factors that may influence implementation of PrEP in family planning clinics: a latent profile analysis

Exploring the heterogeneity of factors that may influence implementation of PrEP in family planning clinics: a latent profile analysis

Pre-Exposure Prophylaxis Integration Into Family Planning Services at Title X Clinics in the Southeastern United States: Protocol for a Mixed Methods Hybrid Type I Effectiveness Implementation Study (Phase 2 ATN 155)

Exploring the Heterogeneity of Factors that may Influence Implementation of PrEP in Family Planning Clinics: A Latent Profile Analysis

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