Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA.
Department of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine, Miami, USA.
BMC Health Serv Res. 2023 Nov 27;23(1):1311. doi: 10.1186/s12913-023-10277-1.
Pre-exposure prophylaxis (PrEP) for HIV prevention is highly effective, but disparities in PrEP access remain considerable, particularly among Black and Latino men who have sex with men (MSM). To address this, the University of Miami Mobile PrEP Program was created, offering mobile HIV prevention/PrEP services in areas throughout South Florida where HIV incidence is high and PrEP access is geographically limited. Using a community-centered participatory approach, the program strategized and executed expansion into the Liberty City neighborhood of Miami. This study qualitatively assessed factors affecting Mobile PrEP implementation as perceived by community stakeholders, clients, and program staff.
Forty-one in-depth interviews were conducted with 21 Mobile PrEP clients, 10 key informants from local health organizations, and 10 program staff. Interview questions queried perceived organizational and positional barriers and facilitators to mobile clinic implementation. Service satisfaction, setting preferences, social factors, and likelihood of recommending Mobile PrEP were also assessed. A thematic content analysis was performed using the Consolidated Framework for Implementation Research (CFIR) taxonomy as the guiding constructs for the analysis.
Participant statements indicated that providing no-cost services, convenient location, program-covered rideshares, individualized patient navigation, and a community-centric approach to patient care, which included staff members with shared lived experiences to increase positive interactions and renewed trust among poorly served communities, were facilitators of PrEP access and intervention uptake. The importance of program familiarization with the community before implementation, particularly for Black and African American communities, who may experience unique barriers to accessing sexual healthcare was strongly emphasized by participants.
The Mobile PrEP intervention was found to be an acceptable and accessible mode of HIV/STI preventive care. The importance of pre-implementation community engagement and preparation is emphasized. Future research is needed to refine understanding of the intervention's components and evaluate implementation determinants in other highly impacted neighborhoods.
HIV 预防的暴露前预防（PrEP）非常有效，但 PrEP 的获取仍然存在很大差异，尤其是在与男性发生性关系的黑人和拉丁裔男同性恋者（MSM）中。为了解决这个问题，迈阿密大学创建了移动 PrEP 计划，在南佛罗里达州 HIV 发病率高且 PrEP 获取地理位置有限的地区提供移动 HIV 预防/PrEP 服务。该计划采用以社区为中心的参与式方法，制定并执行了向迈阿密自由城社区扩张的战略。本研究定性评估了社区利益相关者、客户和项目工作人员认为影响移动 PrEP 实施的因素。
对 21 名移动 PrEP 客户、10 名来自当地卫生组织的主要信息员和 10 名项目工作人员进行了 41 次深入访谈。访谈问题询问了对移动诊所实施的组织和职位障碍和促进因素的看法。还评估了服务满意度、设置偏好、社会因素以及推荐移动 PrEP 的可能性。使用综合实施研究框架（CFIR）分类法作为分析的指导结构，对服务满意度、设置偏好、社会因素以及推荐移动 PrEP 的可能性进行了主题内容分析。
参与者的陈述表明，提供免费服务、方便的位置、项目覆盖的拼车、个性化的患者导航以及以社区为中心的患者护理方法，包括具有共同生活经验的工作人员，以增加互动和在服务不足的社区中重新建立信任，是 PrEP 获取和干预措施采用的促进因素。参与者强烈强调了在实施前对社区进行熟悉的重要性，特别是对于可能面临独特的性健康护理获取障碍的黑人和非裔美国社区。
移动 PrEP 干预措施被认为是一种可接受和可获得的 HIV/性传播感染预防护理模式。强调了实施前社区参与和准备的重要性。需要进一步研究来完善对干预措施组成部分的理解，并评估其他受影响严重社区的实施决定因素。
