Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY, 10467, USA.
Latino Commission on AIDS, New York, NY, USA.
J Community Health. 2023 Dec;48(6):994-1003. doi: 10.1007/s10900-023-01266-w. Epub 2023 Aug 7.
Community-based organizations (CBOs) deliver services in culturally-responsive ways, and could effectively partner with health centers to deliver HIV pre-exposure prophylaxis (PrEP) to Latino men who have sex with men (LMSM). However, few such models exist. We conducted a planning study in collaboration with three CBOs serving LMSM to identify optimal PrEP delivery strategies for health centers and CBOs to implement jointly. We established a Community Expert Panel (CEP) of eight client-facing CBO and health center staff. Over 6 months, the panel met monthly to identify collaborative strategies for PrEP delivery, using a modified Delphi method consisting of the following steps: (1) brainstorming strategies; (2) rating strategies on acceptability, appropriateness and feasibility; (3) review of data from qualitative focus group discussions with CBO clients; and (4) final strategy selection. The panel initially identified 25 potential strategies spread across three categories: improving communication between health centers and CBOs; using low-barrier PrEP options (e.g. telemedicine), and developing locally-relevant, culturally-sensitive outreach materials. Focus groups with CBO clients highlighted a desire for flexible options for PrEP-related care and emphasized trust in CBOs. The final package of strategies consisted of: (1) a web-based referral tool; (2) telemedicine appointments; (3) geographically-convenient options for lab specimen collection; (4) tailored print and social media; and (5) regular coaching sessions with CBO staff. Through a community-engaged process, we identified a package of PrEP delivery strategies that CBOs and health centers can implement in partnership, which have the potential to overcome barriers to PrEP for LMSM.
社区组织（CBO）以文化响应的方式提供服务，并且可以与健康中心有效合作，为与男性发生性关系的拉丁裔男性（LMSM）提供艾滋病毒暴露前预防（PrEP）。然而，这样的模式很少。我们与三个服务于 LMSM 的 CBO 合作进行了一项规划研究，以确定健康中心和 CBO 共同实施的最佳 PrEP 提供策略。我们成立了一个由八名面向客户的 CBO 和健康中心工作人员组成的社区专家小组（CEP）。在六个月的时间里，小组每月开会一次，确定 PrEP 提供的合作策略，使用包括以下步骤的改良 Delphi 方法：（1）集思广益策略；（2）根据可接受性、适当性和可行性对策略进行评分；（3）审查与 CBO 客户进行的定性焦点小组讨论的数据；（4）最终策略选择。小组最初确定了 25 种潜在策略，分布在三个类别中：改善健康中心和 CBO 之间的沟通；使用低门槛 PrEP 选项（例如远程医疗），以及开发具有本地相关性和文化敏感性的外展材料。与 CBO 客户进行的焦点小组强调了对 PrEP 相关护理的灵活选择的愿望，并强调了对 CBO 的信任。最终的策略包包括：（1）基于网络的转介工具；（2）远程医疗预约；（3）便于收集实验室样本的地理位置；（4）量身定制的印刷和社交媒体；（5）定期与 CBO 工作人员进行辅导会议。通过社区参与的过程，我们确定了一套 CBO 和健康中心可以合作实施的 PrEP 提供策略，这些策略有可能克服 LMSM 接受 PrEP 的障碍。
