Bonett Stephen, Mahajan Anjali, da Silva Daniel Teixeira, Williams Javontae, Brady Kathleen, Bauermeister José, Wood Sarah M
School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
The University of Oxford, Oxford, England.
Implement Sci Commun. 2024 Jan 5;5(1):4. doi: 10.1186/s43058-023-00543-y.
Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method and a key component of Philadelphia's Community Plan to End the HIV Epidemic (EHE). However, significant barriers to accessing PrEP exist among people at risk for HIV. Low-threshold models for PrEP services that minimize barriers to entry and service engagement could help bolster access to PrEP through community-based clinics. This study aimed to describe the initial implementation of low-threshold PrEP services in three sexual health clinics funded by the Philadelphia Department of Public Health and explore strategies for delivering low-threshold PrEP services.
We conducted three focus groups with staff (i.e., providers, prevention navigators, and administrative staff, N = 21) at each of three participating PDPH-funded sexual health clinics from November 2021 to January 2022. Discussion topics included details about the PrEP delivery process, clinic strengths and assets, resource gaps, and PrEP implementation goals. Follow-up interviews with staff members (N = 8) between March 2022 and May 2022 focused on identifying successful strategies for PrEP delivery and adaptations needed to optimize low-threshold PrEP service delivery. Rapid qualitative methods and the Consolidated Framework for Implementation Science were used to analyze data from focus groups and interviews.
Participants collaborated to create process maps that visualized the steps involved in delivering PrEP services within their respective settings. These maps highlighted several stages in PrEP service delivery, such as connecting individuals to services, providing prevention navigation, conducting clinical encounters, and ensuring follow-up care. Participants described effective strategies for implementing PrEP, which included integrating and co-locating services on-site, strengthening staffing resources and capacity, and addressing barriers experienced by clients.
Lessons from the implementation of low-threshold PrEP service delivery in Philadelphia can guide ongoing local adaptations and future scale-up of these models to improve access to PrEP and advance the goals of the EHE initiative.
暴露前预防（PrEP）是一种有效的艾滋病毒预防方法，也是费城终结艾滋病毒流行社区计划（EHE）的关键组成部分。然而，艾滋病毒高危人群在获取PrEP方面存在重大障碍。降低门槛的PrEP服务模式能够将进入和参与服务的障碍降至最低，有助于通过社区诊所增加PrEP的可及性。本研究旨在描述由费城市公共卫生部门资助的三家性健康诊所中低门槛PrEP服务的初步实施情况，并探索提供低门槛PrEP服务的策略。
2021年11月至2022年1月，我们在三家参与研究的由PDPH资助的性健康诊所分别与工作人员（即提供者、预防导航员和行政人员，N = 21）进行了三次焦点小组讨论。讨论主题包括PrEP提供过程的细节、诊所的优势和资产、资源差距以及PrEP实施目标。2022年3月至5月对工作人员（N = 8）进行的后续访谈重点在于确定PrEP提供的成功策略以及优化低门槛PrEP服务提供所需的调整。采用快速定性方法和实施科学综合框架对焦点小组和访谈的数据进行分析。
参与者共同协作绘制了流程图，直观展示了各自环境中提供PrEP服务所涉及的步骤。这些流程图突出了PrEP服务提供的几个阶段，如将个人与服务联系起来、提供预防导航、进行临床问诊以及确保后续护理。参与者描述了实施PrEP的有效策略，包括在现场整合服务并将其集中设置、加强人员配备资源和能力，以及解决客户遇到的障碍。
费城低门槛PrEP服务实施的经验教训可为当前的本地调整以及未来扩大这些模式提供指导，以改善PrEP的可及性并推进EHE倡议的目标。
