Implementation interventions for pre-exposure prophylaxis (PrEP) in public health sexually transmitted infections clinic and related PrEP minority trends
Julie Schexnayder, PhD(c), DNP, MPH, ACNP-BC
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Pre-exposure prophylaxis (PrEP) effectively reduces the risk of Human Immunodeficiency Virus (HIV) infection. PrEP implementation in public health clinics is suggested for increasing PrEP access; However, it is unclear if these venues can reduce the disparities in PrEP use that are observed for Black and Latinx adults.
We analyzed data from health departments completing their first PrEP program year between June 1, 2016 and June 30, 2019. We estimated PrEP coverage and adherence in Black and Latinx clients. Semi-structured interviews were conducted with multidisciplinary public health workers (n=6). The Consolidated Framework for Implementation guided a thematic analysis of interviews.
Of the 433 PrEP clients, 52.0% were non-Hispanic Black and 8.9% were Hispanic/Latinx. PrEP to need ratios were greater for White clients than for Black or Latinx clients at five of the nine health departments. The average medication possession ratio for Black and Latinx PrEP clients (.79) approached effective daily adherence levels. However, a single prescription was filled for 25.0% of Black and Latinx clients. Qualitative data indicated compatibility issues between PrEP services delivery and community preferences and needs. Challenges integrating longitudinal follow-up practices, and complex PrEP re-enrollment procedures emerged as additional factors influencing PrEP outcomes.
The results of this dissertation indicate that public health clinics vary in their ability to deliver all components of PrEP clinical monitoring and in their ability to increase PrEP coverage in Black and Latinx adults. Tailoring of PrEP services to Black and Latinx adults may be necessary to optimize PrEP coverage and adherence.
The submitter is a recipient of the 2018-2019 Sigma Theta Tau International Honor Society of Nursing and Association of Nurses in AIDS Care grant award. The presentation slides are a part of the submitter's dissertation defense.
The Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the Sigma grant. No further peer-review has taken place upon the completion of the Sigma grant final report and its appearance in this repository.
|Review Type||None: Sigma Grant Recipient Report|
|Research Approach||Mixed/Multi Method Research|
|Keywords||HIV Pre-Exposure Prophylaxis;
Pre-Exposure Prophylaxis (PrEP);
Public Health Clinics;
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