School of Medicine, Emory University, Atlanta, GA, USA.
Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
J Gen Intern Med. 2021 Oct;36(10):2958-2965. doi: 10.1007/s11606-020-06509-3. Epub 2021 Jan 14.
HIV pre-exposure prophylaxis (PrEP) is underutilized by US women. Cost and resource concerns are barriers to PrEP delivery in settings that see men. Family planning clinics may be ideal PrEP delivery settings for women, but as they are not uniform in their clinical services, cost and resource concerns may vary.
We examined factors that influence perceptions of costs and resources related to PrEP delivery in Title X-funded family planning clinics in Southern states, which overlaps with high HIV-burden areas.
We conducted a web-based survey among a convenience sample of clinicians and administrators of Title X clinics across 18 Southern states (DHHS regions III, IV, VI). We compared cost- and resource-related survey items and other clinic- and county-level variables between clinics by whether their clinics also provided other primary care services. We analyzed interviews for cost and resource themes.
Title X clinic staff in the South.
Among 283 unique clinics, a greater proportion of clinics that also provided primary care currently provided PrEP compared with those that did not provide primary care (27.8% vs. 18.3%, p = 0.06), but this difference was not statistically significant. Among 414 respondents in clinics that were not providing PrEP, those in clinics with primary care services were more likely to respond that they had the necessary financial resources (p < 0.01) and staffing (p < 0.01) for PrEP implementation compared to those without primary care services. In interviews, respondents differed on concerns about costs of labs and staffing based on whether their clinic had concomitant primary care services or not.
Among publicly funded Southern family planning clinics, current PrEP provision was higher among clinics with concomitant primary care. Among clinics not providing PrEP, those with concomitant primary care services have lower perceived cost and resource barriers and therefore may be optimal for expanding PrEP among women.
艾滋病毒暴露前预防（PrEP）在美国女性中的使用率较低。在男性就诊的环境中，成本和资源问题是 PrEP 提供的障碍。计划生育诊所可能是女性提供 PrEP 的理想场所，但由于它们的临床服务并不统一，因此成本和资源问题可能会有所不同。
我们研究了影响南方各州接受联邦拨款的计划生育诊所（Title X）提供 PrEP 的成本和资源相关认知的因素，这些诊所与艾滋病毒负担较高的地区重叠。
我们在南方 18 个州（卫生与公众服务部第 III、IV 和 VI 地区）的 Title X 诊所的临床医生和管理人员中进行了一项基于网络的调查。我们比较了那些同时提供其他初级保健服务的诊所和那些没有提供初级保健服务的诊所的成本和资源相关调查项目以及其他诊所和县级变量。我们对成本和资源主题进行了访谈分析。
南方 Title X 诊所的工作人员。
在 283 家独特的诊所中，与那些不提供初级保健的诊所相比，那些同时提供初级保健的诊所目前提供 PrEP 的比例更高（27.8%比 18.3%，p = 0.06），但这一差异无统计学意义。在没有提供 PrEP 的 414 名受访者中，那些在提供初级保健服务的诊所中，与那些没有初级保健服务的诊所相比，更有可能回答他们有实施 PrEP 的必要财务资源（p < 0.01）和人员配置（p < 0.01）。在访谈中，根据诊所是否有同时提供的初级保健服务，受访者对实验室和人员配备成本的担忧存在差异。
在南方公共资助的计划生育诊所中，与初级保健并存的诊所提供的 PrEP 更高。在没有提供 PrEP 的诊所中，那些提供初级保健服务的诊所认为成本和资源障碍较低，因此可能是扩大女性 PrEP 服务的理想选择。
