Division of Adolescent Medicine, Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
Subst Use Addctn J. 2024 Oct;45(4):548-558. doi: 10.1177/29767342241274077. Epub 2024 Sep 5.
People with substance use disorder (SUD) are at increased risk of HIV infection. HIV testing and pre-exposure prophylaxis (PrEP) are evidence-based practices to prevent HIV infection, yet these approaches are not regularly provided in SUD treatment programs. To address this evidence-to-practice gap, this study aimed to identify facilitators and barriers to implementing PrEP services in SUD treatment programs from the perspective of non-medical staff and administrators.
Semi-structured interviews were conducted from February to June 2022 with non-medical staff (N = 10) and administrators (N = 11) from 3 academic and 8 community-based SUD treatment programs in Philadelphia. Interview guides were developed using the Consolidated Framework for Implementation Research (CFIR). Qualitative descriptive techniques were used to examine interview data and identify key facilitators and barriers, which were grouped within CFIR domains and constructs.
Of the 11 SUD treatment programs, 5 provided PrEP services. Most interviewees at programs without PrEP services reported high levels of receptivity to implementing PrEP and identified leadership engagement as a key determinant, but several lacked comfort with PrEP counseling. Inner setting facilitators included compatibility with workflows (eg, intake assessments), alignment with cultures of holistic care, and programs' longstanding community trust. Inner setting barriers included limited time to discuss PrEP, insufficient resources and staff (eg, phlebotomy), perception of clients' HIV risk, and lower prioritization of HIV prevention versus other services. Intervention facilitators included robust evidence and addressing costs through grants and drug pricing programs, and barriers included the time needed to initiate PrEP, loss to follow-up, and HIV stigma.
Successful implementation of HIV testing and PrEP in SUD treatment programs requires addressing multi-level barriers. Including perspectives of non-medical staff and administrators is important for implementation. Potential strategies include supporting organizational networks, leveraging peer specialists' expertise, and packaging PrEP to better meet client priorities and needs.
患有物质使用障碍（SUD）的人感染 HIV 的风险增加。HIV 检测和暴露前预防（PrEP）是预防 HIV 感染的循证实践，但这些方法并未在 SUD 治疗计划中定期提供。为了解决这一从证据到实践的差距，本研究旨在从非医疗人员和管理人员的角度确定在 SUD 治疗计划中实施 PrEP 服务的促进因素和障碍。
2022 年 2 月至 6 月，对费城 3 所学术和 8 所社区 SUD 治疗中心的非医疗人员（N=10）和管理人员（N=11）进行了半结构化访谈。访谈指南使用实施研究综合框架（CFIR）制定。使用定性描述技术检查访谈数据，确定关键的促进因素和障碍，这些因素和障碍在 CFIR 领域和结构中分组。
在 11 个 SUD 治疗计划中，有 5 个提供 PrEP 服务。没有 PrEP 服务的项目中，大多数受访者表示对实施 PrEP 非常接受，并认为领导力参与是一个关键决定因素，但一些人对 PrEP 咨询感到不舒服。内部环境促进因素包括与工作流程（例如，摄入评估）的兼容性、与整体护理文化的一致性以及项目长期的社区信任。内部环境障碍包括讨论 PrEP 的时间有限、资源和人员（例如，采血）不足、对客户 HIV 风险的看法以及将 HIV 预防置于其他服务之下的优先级较低。干预措施的促进因素包括强有力的证据以及通过赠款和药品定价计划来解决成本问题，障碍包括启动 PrEP 所需的时间、随访丢失以及 HIV 耻辱感。
在 SUD 治疗计划中成功实施 HIV 检测和 PrEP 需要解决多层次的障碍。纳入非医疗人员和管理人员的观点对于实施很重要。潜在的策略包括支持组织网络、利用同伴专家的专业知识以及包装 PrEP，以更好地满足客户的优先事项和需求。
