Liegeon Geoffroy, Devlin Samantha A, Manda Victoria, Castaneda Julie, Toribio Myriam, Florence Sophie, Ridgway Jessica P, Johnson Amy K
Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America.
Department of Infectious Diseases, Saint-Louis Hospital, Paris, France.
PLoS One. 2025 Jun 2;20(6):e0325078. doi: 10.1371/journal.pone.0325078. eCollection 2025.
Pre-exposure prophylaxis (PrEP) for HIV remains largely underused among women who have migrated from sub-Saharan Africa (WMSSA), despite their accounting for a significant proportion of new HIV diagnoses in France and Western European countries. To expand PrEP reach, we explored healthcare providers' perspectives on PrEP implementation within family planning centers (FPCs) in the Paris region through focus groups. The focus group discussion guide and rapid content analysis were informed by the Consolidated Framework for Implementation Research (CFIR) 2.0, which uses five domains to capture implementation determinants (Innovation, Outer Setting, Inner Setting, Individuals, and Implementation Process). Twenty providers participated across five focus groups and one key informant interview (median age 45; 80% women, 70% physicians). Oral PrEP was seen as easy to prescribe, but providers advocated for choices beyond the daily pill for better acceptability. While providers recognized increased HIV prevention needs among WMSSA, they found low PrEP demand among women stemming from a lack of knowledge. Although providers acknowledged that PrEP aligned with FPC missions, they cited significant implementation barriers, including limited resources, staff shortages, insufficient on-site capacity, competing priorities, and physicians being the sole prescribers. Provider-level implementation challenges included insufficient training and discomfort in discussing HIV risk and PrEP with WMSSA. Recommendations for implementing PrEP within FPCs included provider training and mentorship, tailored information campaigns for WMSSA, flexible delivery processes, support groups for women, and authorizing midwives and nurses to prescribe PrEP. These results support the need for tailored and multi-level implementation strategies to increase PrEP uptake among WMSSA attending FPCs in France.
尽管来自撒哈拉以南非洲的移民女性（WMSSA）在法国和西欧国家新确诊的艾滋病毒感染者中占相当大的比例，但艾滋病毒暴露前预防（PrEP）在她们当中的使用率仍然很低。为了扩大PrEP的覆盖范围，我们通过焦点小组探讨了巴黎地区计划生育中心（FPC）内医疗服务提供者对PrEP实施的看法。焦点小组讨论指南和快速内容分析参考了实施研究综合框架（CFIR）2.0，该框架使用五个领域来捕捉实施决定因素（创新、外部环境、内部环境、个人和实施过程）。五个焦点小组和一次关键信息人访谈共有20名提供者参与（中位年龄45岁；80%为女性，70%为医生）。口服PrEP被认为易于开处方，但提供者主张除了每日服药之外还有其他选择，以提高可接受性。虽然提供者认识到WMSSA中艾滋病毒预防需求增加，但他们发现女性中PrEP需求低是由于缺乏知识。尽管提供者承认PrEP与FPC的使命相符，但他们指出了重大的实施障碍，包括资源有限、人员短缺、现场能力不足、相互竞争的优先事项以及医生是唯一的开处方者。提供者层面的实施挑战包括培训不足以及与WMSSA讨论艾滋病毒风险和PrEP时感到不自在。在FPC内实施PrEP的建议包括提供者培训和指导、针对WMSSA的量身定制的宣传活动、灵活的提供流程、女性支持小组以及授权助产士和护士开PrEP。这些结果支持需要采取量身定制的多层次实施策略，以提高在法国就诊于FPC的WMSSA中PrEP的使用率。
