Facilitators and Barriers to Equitable Implementation of Telehealth PrEP Delivery: A Qualitative Descriptive Study of Program Staff and Stakeholders.

Expanding access to pre-exposure prophylaxis (PrEP) is crucial for ending the HIV epidemic in the United States and reducing disparities in HIV incidence among marginalized populations. Telehealth models for the delivery of PrEP have the potential to improve access, acceptability, and adherence. In 2022, Philadelphia established the Philadelphia TelePrEP Program to deliver HIV prevention services through telehealth. This qualitative descriptive study aims to identify implementation determinants for telehealth PrEP services in Philadelphia. We completed nine in-depth interviews with staff at the Philadelphia TelePrEP Program (n = 5) and external stakeholders in the HIV prevention workforce (n = 4) using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR). Thematic analysis was used to identify key facilitators and barriers to implementation. Interviews revealed that telePrEP improved convenience and flexibility in accessing PrEP, but online marketing may exclude certain populations with limited digital presence. Dedicated patient navigators and ongoing staff training were key facilitators, whereas limited provider capacity was a challenge. Sustainable funding through grants and 340B revenue enabled the Philadelphia TelePrEP Program to serve uninsured patients. The digital divide, lack of PrEP awareness, and competition from commercial telePrEP providers were identified as potential barriers to engaging priority populations. TelePrEP has the potential to expand the availability of PrEP services and reach communities that currently face barriers to access. However, overcoming key structural and social barriers around public awareness, technology access, and organizational capacity will be critical for successful implementation.