Bonett Stephen, Sweeney Anna, Li Qian, Watson Dovie L, Bauermeister José, Hernandez Brian, Williams Javontae, Brady Kathleen A
The University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
University of Pennsylvania, Philadelphia, PA, USA.
Health Promot Pract. 2025 Jun 19:15248399251347253. doi: 10.1177/15248399251347253.
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.
扩大暴露前预防（PrEP）的可及性对于在美国终结艾滋病毒流行以及减少边缘化人群中艾滋病毒感染率的差异至关重要。提供PrEP的远程医疗模式有潜力改善可及性、可接受性和依从性。2022年，费城设立了费城远程PrEP项目，通过远程医疗提供艾滋病毒预防服务。这项定性描述性研究旨在确定费城远程医疗PrEP服务的实施决定因素。我们使用基于实施研究综合框架（CFIR）的半结构化访谈指南，对费城远程PrEP项目的工作人员（n = 5）和艾滋病毒预防工作队伍中的外部利益相关者（n = 4）进行了九次深入访谈。采用主题分析法确定实施的关键促进因素和障碍。访谈显示，远程PrEP提高了获取PrEP的便利性和灵活性，但在线营销可能会将某些数字参与度有限的人群排除在外。专门的患者导航员和持续的工作人员培训是关键促进因素，而提供者能力有限是一项挑战。通过赠款和340B收入获得的可持续资金使费城远程PrEP项目能够为未参保患者提供服务。数字鸿沟、缺乏PrEP意识以及来自商业远程PrEP提供者的竞争被确定为吸引优先人群的潜在障碍。远程PrEP有潜力扩大PrEP服务的可及范围，并覆盖目前面临获取障碍的社区。然而，克服围绕公众意识、技术获取和组织能力的关键结构和社会障碍对于成功实施至关重要。
