Women's Health Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
AIDS Patient Care STDS. 2020 Jun;34(6):259-266. doi: 10.1089/apc.2020.0004.
We aimed to systematically evaluate the feasibility of integrating HIV prevention services, including pre-exposure 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.
我们旨在系统评估在高 HIV 流行社区将 HIV 预防服务（包括暴露前预防 [PrEP]）整合到计划生育环境中的可行性。我们使用 RE-AIM 框架（覆盖范围、效果、采用、实施、维持）在 6 个月内评估将 HIV 预防服务整合到计划生育诊所中的情况。在整合之前，没有提供 PrEP。我们实施了一项关于 HIV PrEP 的员工培训计划。我们通过病历回顾确定了到诊所就诊的女性中接受筛查、符合 PrEP 条件和开始 PrEP 的比例。我们评估了员工在整合前后对 PrEP 的舒适度。我们比较了计划和实际的实施情况，采访了员工以确定障碍和促进因素，并跟踪了系统的适应情况。我们评估了研究结束后 PrEP 的维持情况。共有 515 名患者的 640 次临床就诊；HIV 咨询和 PrEP 筛查率为 50%。第一个月的筛查率为 10%，第三个月达到 65%。几乎所有接受筛查的患者都符合 PrEP 条件（98.4%），有 15 名患者（6%）开始服用 PrEP。教育后，员工在讨论 PrEP 方面的知识和舒适度有所提高。促进因素包括与当地专家合作、继续教育、提供者的临床工具以及患者教育材料。障碍包括在临床就诊期间存在竞争优先级、有限的以女性为中心的患者教育材料以及与保险相关的障碍。在本试点中，将 HIV 预防服务嵌入计划生育环境是可行的。接受 PrEP 筛查的女性比例迅速增加。在这个 HIV 高流行社区，几乎所有接受筛查的女性都符合条件，有 6%开始服用 PrEP。
