Xavier Hall Casey D, Smith Justin C, Driggers Robert A, Stoller Bethany, Khan Zara, Li Jingjing, Ignatius Elisa H, Siegler Aaron J
Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
AIDS Care. 2021 Jun;33(6):706-711. doi: 10.1080/09540121.2020.1810616. Epub 2020 Aug 24.
New modalities of Pre-exposure Prophylaxis (PrEP) such as long-acting injectable PrEP (LAI-PrEP) promise increased prevention of HIV transmission; however, similar biomedical interventions have not been met with universal adoption by healthcare providers or populations most affected by HIV. This qualitative study explores healthcare provider considerations for the rollout of LAI-PrEP. Eleven key-informant in-depth interviews were conducted with clinicians who prescribe daily oral PrEP. Participants reviewed a currently proposed LAI regimen and were asked to reflect on its implications for their clinical practice. Interviews were transcribed verbatim and thematically coded, with results organized using the Consolidated Framework for Implementation Research (CFIR). All participants expressed interest in prescribing LAI-PrEP and anticipated that at least some patients would be interested. Participants identified characteristics of the intervention, inner intervention setting, and outer intervention setting that will be influential in bringing LAI-PrEP to scale. Clinicians in the South have unique insights into the challenges of and opportunities for successful rollout of future PrEP regimens. Bringing these insights into a CFIR framework highlights the nuances surrounding LAI-PrEP, including structural concerns such as cost barriers and access to in-person healthcare services. It is critical to address these challenges to ensure successful implementation of new PrEP formulations.
暴露前预防（PrEP）的新形式，如长效注射用PrEP（LAI-PrEP），有望增强对HIV传播的预防效果；然而，类似的生物医学干预措施并未得到医疗服务提供者或受HIV影响最严重人群的普遍采用。这项定性研究探讨了医疗服务提供者在推广LAI-PrEP方面的考虑因素。对开具每日口服PrEP的临床医生进行了11次关键信息提供者深入访谈。参与者审查了当前提议的LAI方案，并被要求思考其对临床实践的影响。访谈内容逐字转录并进行主题编码，结果使用实施研究综合框架（CFIR）进行整理。所有参与者都表示有兴趣开具LAI-PrEP，并预计至少有一些患者会感兴趣。参与者确定了干预措施的特征、内部干预环境和外部干预环境，这些因素将对LAI-PrEP的推广产生影响。南方的临床医生对未来PrEP方案成功推广所面临的挑战和机遇有独特见解。将这些见解纳入CFIR框架凸显了围绕LAI-PrEP的细微差别，包括成本障碍和获得面对面医疗服务等结构性问题。应对这些挑战对于确保新PrEP制剂的成功实施至关重要。
