Piper Kaitlin N, Anderson Katherine M, Kokubun Caroline W, Sheth Anandi N, Sales Jessica
Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
Implement Sci Commun. 2023 Jun 9;4(1):64. doi: 10.1186/s43058-023-00450-2.
Title X-funded family planning clinics have been identified as optimal sites for delivery of pre-exposure prophylaxis (PrEP) for HIV prevention to U.S. women. 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.
To understand contextual factors that are key to successful PrEP implementation in family planning clinics, we conducted in-depth qualitative interviews with key informants from 38 family planning clinics (11 clinics prescribed PrEP and 27 did not). Interviews were guided by constructs from the Consolidated Framework for Implementation Research (CFIR), and qualitative comparative analysis (QCA) was used to uncover the configurations of CFIR factors that led to PrEP implementation.
We identified 3 distinct construct configurations, or pathways, that led to successful PrEP implementation: (1) high "Leadership Engagement" AND high "Available Resources"; OR (2) high "Leadership Engagement" AND NOT located in the Southeast region; OR (3) high "Access to Knowledge and Information" AND NOT located in the Southeast region. Additionally, there were 2 solution paths that led to absence of PrEP implementation: (1) low "Access to Knowledge and Information" AND low "Leadership Engagement"; OR (2) low "Available Resources" AND high "External Partnerships".
We identified the most salient combinations of co-occurring organizational barriers or facilitators associated with PrEP implementation across Title X clinics in the Southern U.S. We discuss implementation strategies to promote pathways that led to implementation success, as well as strategies to overcome pathways to implementation failure. Notably, we identified regional differences in the pathways that led to PrEP implementation, with Southeastern clinics facing the most obstacles to implementation, specifically substantial resource constraints. Identifying implementation pathways is an important first step for packaging multiple implementation strategies that could be employed by state-level Title X grantees to help scale up PrEP.
获得第十类计划（Title X）资助的计划生育诊所已被确定为向美国女性提供暴露前预防（PrEP）以预防艾滋病毒的最佳场所。然而，PrEP尚未广泛纳入计划生育服务，尤其是在美国南部，数据表明在这种情况下可能存在重大的实施挑战。
为了解计划生育诊所成功实施PrEP的关键背景因素，我们对38家计划生育诊所（11家诊所开具PrEP处方，27家未开具）的关键信息提供者进行了深入的定性访谈。访谈以实施研究综合框架（CFIR）中的构建为指导，并使用定性比较分析（QCA）来揭示导致PrEP实施的CFIR因素配置。
我们确定了导致PrEP成功实施的3种不同的构建配置或途径：（1）高“领导参与度”且高“可用资源”；或（2）高“领导参与度”且不在东南部地区；或（3）高“知识和信息获取”且不在东南部地区。此外，有2条导致未实施PrEP的解决途径：（1）低“知识和信息获取”且低“领导参与度”；或（2）低“可用资源”且高“外部伙伴关系”。
我们确定了美国南部第十类诊所中与PrEP实施相关的同时出现的组织障碍或促进因素的最显著组合。我们讨论了促进导致实施成功的途径的实施策略，以及克服实施失败途径的策略。值得注意的是，我们确定了导致PrEP实施的途径存在区域差异，东南部诊所面临的实施障碍最大，特别是资源严重受限。确定实施途径是打包多种实施策略的重要第一步，州级第十类受助者可采用这些策略来帮助扩大PrEP的使用规模。
