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Background <p>HIV pre-exposure prophylaxis (PrEP) remains underutilized in communities over-burdened by HIV. Same-day PrEP, prescribing and starting PrEP at the initial visit, may be an implementation strategy to address this gap. Federally qualified health centers (FQHC) and community-based organizations (CBO) provide healthcare to un- and under-insured populations and have the potential to increase PrEP services via same-day PrEP. This exploratory mixed methods study explored same-day PrEP program implementation strategies and determinants.</p> Methods <p>Key stakeholders, recruited from FQHC and CBO in Georgia, Texas, and Illinois, participated in virtual interviews (qualitative strand) grounded in the Consolidated Framework for Implementation Science. Thematic analysis in NVivo identified implementation strategies. Purposively sampled FQHC and CBO stakeholder focus groups (FG) rank-ordered same-day PrEP implementation strategies (quantitative strand) based on perceived effectiveness and feasibility to create meta-inferences. <i>N</i> = 5 individuals participated in both interviews and FG. We then calculated the mean rank order score for each implementation strategy (range = 1–12), within each state and across all three states. We calculated these mean scores separately for both perceived strategy effectiveness/impact and perceived feasibility within their respective settings.</p> Results <p>Twenty-four stakeholders completed interviews. 46% (<i>N</i> = 11) were clinic directors/managers, 63% (<i>N</i> = 15) were&#xa0;affiliated with a CBO, 71% (<i>N</i> = 17) worked in settings where same-day oral PrEP was offered. Theme 1) Medicaid expansion is a useful resource for same-day PrEP implementation; however, same-day PrEP is feasible in non-Medicaid expansion states by leveraging additional financial resources. Theme 2) Leadership buy-in and PrEP champions spearhead programs. Theme 3) Intercommunity relationships and formal evaluation are needed<Emphasis Type="BoldItalic">.</Emphasis> The three most highly ranked strategies in terms of perceived effectiveness were: 1. Leadership buy-in (mean ranking = 2.51); 2. PrEP champion (mean ranking = 3.62); and 3. PrEP navigators (mean ranking = 4.68). Leadership buy-in first (mean ranking = 2.91), followed by the use of a PrEP champion second (mean ranking = 3.91) and consumer outreach (mean ranking = 4.81) were ranked highest in terms of perceived feasibility.</p> Conclusions <p>Diversification of funding, support from leaders, and customization of implementation strategies are consistent factors necessary for same-day PrEP programs.</p>

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Exploration of implementation determinants and strategies for same-day oral PrEP in community-based organizations and federally qualified health centers

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月22日

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  • Samantha V. Hill,
  • Portia Thomas,
  • Mariel Parman,
  • Jeannette Webb,
  • LaRon Nelson,
  • Michael Mugavero,
  • Russell A. Brewer,
  • Latesha Elopre,
  • Larry Herald

摘要

Background

HIV pre-exposure prophylaxis (PrEP) remains underutilized in communities over-burdened by HIV. Same-day PrEP, prescribing and starting PrEP at the initial visit, may be an implementation strategy to address this gap. Federally qualified health centers (FQHC) and community-based organizations (CBO) provide healthcare to un- and under-insured populations and have the potential to increase PrEP services via same-day PrEP. This exploratory mixed methods study explored same-day PrEP program implementation strategies and determinants.

Methods

Key stakeholders, recruited from FQHC and CBO in Georgia, Texas, and Illinois, participated in virtual interviews (qualitative strand) grounded in the Consolidated Framework for Implementation Science. Thematic analysis in NVivo identified implementation strategies. Purposively sampled FQHC and CBO stakeholder focus groups (FG) rank-ordered same-day PrEP implementation strategies (quantitative strand) based on perceived effectiveness and feasibility to create meta-inferences. N = 5 individuals participated in both interviews and FG. We then calculated the mean rank order score for each implementation strategy (range = 1–12), within each state and across all three states. We calculated these mean scores separately for both perceived strategy effectiveness/impact and perceived feasibility within their respective settings.

Results

Twenty-four stakeholders completed interviews. 46% (N = 11) were clinic directors/managers, 63% (N = 15) were affiliated with a CBO, 71% (N = 17) worked in settings where same-day oral PrEP was offered. Theme 1) Medicaid expansion is a useful resource for same-day PrEP implementation; however, same-day PrEP is feasible in non-Medicaid expansion states by leveraging additional financial resources. Theme 2) Leadership buy-in and PrEP champions spearhead programs. Theme 3) Intercommunity relationships and formal evaluation are needed. The three most highly ranked strategies in terms of perceived effectiveness were: 1. Leadership buy-in (mean ranking = 2.51); 2. PrEP champion (mean ranking = 3.62); and 3. PrEP navigators (mean ranking = 4.68). Leadership buy-in first (mean ranking = 2.91), followed by the use of a PrEP champion second (mean ranking = 3.91) and consumer outreach (mean ranking = 4.81) were ranked highest in terms of perceived feasibility.

Conclusions

Diversification of funding, support from leaders, and customization of implementation strategies are consistent factors necessary for same-day PrEP programs.