scholarly journals Pre-Exposure Prophylaxis Integration Into Family Planning Services at Title X Clinics in the Southeastern United States: Protocol for a Mixed Methods Hybrid Type I Effectiveness Implementation Study (Phase 2 ATN 155)

10.2196/18784 ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. e18784
Author(s):  
Anandi N Sheth ◽  
Sophia A Hussen ◽  
Cam Escoffery ◽  
Lisa B Haddad ◽  
Leah Powell ◽  
...  
Keyword(s):  
United States ◽  
Southern United States ◽  
Implementation Study ◽  
Phase 2 ◽  
Title X ◽  
Factors Associated ◽  
Adoption And Implementation ◽  
Prep Implementation ◽  
Exposure Prophylaxis

Background Adolescent and young adult women (AYAW), particularly racial and ethnic minorities, in the Southern United States are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is an effective, scalable, individual-controlled HIV prevention strategy that is grossly underutilized among women of all ages and requires innovative delivery approaches to optimize its benefit. Anchoring PrEP delivery to family planning (FP) services that AYAW already trust, access routinely, and deem useful for their sexual health may offer an ideal opportunity to reach women at risk for HIV and to enhance their PrEP uptake and adherence. However, PrEP has not been widely integrated into FP services, including Title X–funded FP clinics that provide safety net sources of care for AYAW. To overcome potential implementation challenges for AYAW, Title X clinics in the Southern United States are uniquely positioned to be focal sites for conceptually informed and thoroughly evaluated PrEP implementation science studies. Objective The objective of this study is two-fold: to evaluate multilevel factors associated with the level of PrEP adoption and implementation (eg, PrEP screening, counseling, and prescription) within and across 3 FP clinics and to evaluate PrEP uptake, persistence, and adherence among female patients in these clinics over a 6-month follow-up period. Methods Phase 2 of Planning4PrEP (Adolescent Medicine Trials Network for HIV/AIDS Interventions 155) is a mixed methods hybrid type 1 effectiveness implementation study to be conducted in three clinics in Metro Atlanta, Georgia, United States. Guided by the Exploration, Preparation, Implementation, and Sustainment framework, this study will prepare clinics for PrEP integration via clinic-wide trainings and technical assistance and will develop clinic-specific PrEP implementation plans. We will monitor and evaluate PrEP implementation as well as female patient PrEP uptake, persistence, and adherence over a 6-month follow-up period. Results Phase 2 of Planning4PrEP research activities began in February 2018 and are ongoing. Qualitative data analysis is scheduled to begin in Fall 2020. Conclusions This study seeks to evaluate factors associated with the level of PrEP adoption and implementation (eg, PrEP screening, counseling, and prescription) within and across 3 FP clinics following training and implementation planning and to evaluate PrEP uptake, persistence, and adherence among female patients over a 6-month follow-up period. This will guide future strategies to support PrEP integration in Title X–funded clinics across the Southern United States. Trial Registration ClinicalTrials.gov NCT04097834; https://clinicaltrials.gov/ct2/show/NCT04097834 International Registered Report Identifier (IRRID) DERR1-10.2196/18784

scholarly journals Pre-Exposure Prophylaxis Integration Into Family Planning Services at Title X Clinics in the Southeastern United States: Protocol for a Mixed Methods Hybrid Type I Effectiveness Implementation Study (Phase 2 ATN 155) (Preprint)

2020 ◽  
Author(s):  
Anandi N Sheth ◽  
Sophia A Hussen ◽  
Cam Escoffery ◽  
Lisa B Haddad ◽  
Leah Powell ◽  
...  
Keyword(s):  
United States ◽  
Southern United States ◽  
Implementation Study ◽  
Phase 2 ◽  
Title X ◽  
Factors Associated ◽  
Adoption And Implementation ◽  
Prep Implementation ◽  
Exposure Prophylaxis

BACKGROUND Adolescent and young adult women (AYAW), particularly racial and ethnic minorities, in the Southern United States are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is an effective, scalable, individual-controlled HIV prevention strategy that is grossly underutilized among women of all ages and requires innovative delivery approaches to optimize its benefit. Anchoring PrEP delivery to family planning (FP) services that AYAW already trust, access routinely, and deem useful for their sexual health may offer an ideal opportunity to reach women at risk for HIV and to enhance their PrEP uptake and adherence. However, PrEP has not been widely integrated into FP services, including Title X–funded FP clinics that provide safety net sources of care for AYAW. To overcome potential implementation challenges for AYAW, Title X clinics in the Southern United States are uniquely positioned to be focal sites for conceptually informed and thoroughly evaluated PrEP implementation science studies. OBJECTIVE The objective of this study is two-fold: to evaluate multilevel factors associated with the level of PrEP adoption and implementation (eg, PrEP screening, counseling, and prescription) within and across 3 FP clinics and to evaluate PrEP uptake, persistence, and adherence among female patients in these clinics over a 6-month follow-up period. METHODS Phase 2 of Planning4PrEP (Adolescent Medicine Trials Network for HIV/AIDS Interventions 155) is a mixed methods hybrid type 1 effectiveness implementation study to be conducted in three clinics in Metro Atlanta, Georgia, United States. Guided by the Exploration, Preparation, Implementation, and Sustainment framework, this study will prepare clinics for PrEP integration via clinic-wide trainings and technical assistance and will develop clinic-specific PrEP implementation plans. We will monitor and evaluate PrEP implementation as well as female patient PrEP uptake, persistence, and adherence over a 6-month follow-up period. RESULTS Phase 2 of Planning4PrEP research activities began in February 2018 and are ongoing. Qualitative data analysis is scheduled to begin in Fall 2020. CONCLUSIONS This study seeks to evaluate factors associated with the level of PrEP adoption and implementation (eg, PrEP screening, counseling, and prescription) within and across 3 FP clinics following training and implementation planning and to evaluate PrEP uptake, persistence, and adherence among female patients over a 6-month follow-up period. This will guide future strategies to support PrEP integration in Title X–funded clinics across the Southern United States. CLINICALTRIAL ClinicalTrials.gov NCT04097834; https://clinicaltrials.gov/ct2/show/NCT04097834 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18784

scholarly journals Family Planning Provider Referral, Facilitation Behavior, and Patient Follow-up for Abnormal Pap Smears

2009 ◽  
Vol 124 (5) ◽  
pp. 733-744 ◽  
Author(s):  
Holly C. Felix ◽  
Janet Bronstein ◽  
Zoran Bursac ◽  
M. Kathryn Stewart ◽  
H. Russell Foushee ◽  
...  
Keyword(s):  
Family Planning ◽  
Pap Smear ◽  
Health Department ◽  
Institutional Setting ◽  
Pap Smears ◽  
Title X ◽  
Rural Location ◽  
Factors Associated ◽  
Follow Up Care

Objectives. Family planning (FP) clinics are important access points for cervical cancer screening and referrals for follow-up care for abnormal Papanicolaou (Pap) smears for a substantial number of U.S. women. Because little is known about referral and facilitation practices in these clinics or client action based on referrals, we sought to determine FP provider referral and facilitation practices when seeing FP clients with abnormal Pap smear results, and FP client follow-up for abnormal Pap smears due to FP provider referrals. Methods. We conducted a mail survey of Medicaid-enrolled FP providers in Arkansas and Alabama, and conducted a telephone survey with a sample of FP clients of those providers responding to the provider survey. Results. Major provider factors associated with referral included rural location, health department and clinic institutional setting, large Title X practice/clinic size, and high FP clinic focus. Major factors associated with facilitation included rural location, non-physician specialty, health department and clinic institutional setting, and small Title X clinic size. Of women reporting abnormal results, 62.4% reported follow-up care. Of those who received follow-up care, 40.0% received some care and a referral from their FP provider. A major factor associated with clients seeking follow-up care was being told by their FP provider where to go for follow-up care. Age was a major factor associated with clients actually obtaining follow-up care. Conclusions. Where follow-up care is not available at the FP site, referrals are critical and are a major factor associated with whether women seek care for the condition. Interventions to increase follow-up rates should focus on provider and system features, rather than clients.

scholarly journals 852. Bridging the Gap in PrEP Provider Training: An Implementation Science Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S516-S516
Author(s):  
Aditi Ramakrishnan ◽  
Jessica Sales ◽  
Micah McCumber ◽  
Matthew Psioda ◽  
Leah Powell ◽  
...  
Keyword(s):  
Self Efficacy ◽  
Mixed Model ◽  
Healthcare Providers ◽  
Provider Training ◽  
Southern States ◽  
Significant Difference ◽  
Initiation Step ◽  
Prep Implementation ◽  
Exposure Prophylaxis

Abstract Background Training healthcare providers in a variety of clinical settings to deliver pre-exposure prophylaxis (PrEP) is a key component of the Ending the HIV Epidemic (EHE) initiative. Self-efficacy, the individual’s belief in their ability to carry out the steps of PrEP delivery, is a core part of provider training and necessary for successful PrEP implementation. We characterized self-efficacy among providers from family planning (FP) clinics that do not provide PrEP to inform provider training strategies. Methods We surveyed providers (any clinical staff who could screen, counsel, or prescribe PrEP) from FP clinics in 18 Southern states (Feb-June 2018, N=325 respondents from 224 clinics not providing PrEP) using contraception- and PrEP-specific self-efficacy questions (overall and grouped into PrEP delivery steps: screening, initiation, and follow-up). We compared self-efficacy scores (5-point Likert scale) by prescriber status, between PrEP delivery steps, and used linear mixed models to analyze provider-, clinic-, and county-level covariates associated with overall PrEP self-efficacy. Results Among 325 FP providers, self-efficacy scores were lowest in the PrEP initiation step, higher in follow-up, and highest in screening (p < 0.0001, Table). Mean overall PrEP self-efficacy scores were significantly higher among prescribers compared to non-prescribers (p < 0.0001). However, providers reported lowest self-efficacy regarding insurance navigation for PrEP with no significant difference by prescriber status. The mixed model demonstrated overall PrEP self-efficacy was positively associated with favorable PrEP attitudes among non-prescribers, PrEP knowledge among prescribers, and contraception self-efficacy in both groups, but was not associated with availability of insurance navigation on-site or other covariates (Figure). Provider Self-Efficacy along the PrEP Delivery Model stratified by prescriber status Conclusion FP providers reported low confidence in their ability to perform the steps that comprise PrEP initiation. Provider training focused on elements of PrEP initiation are critical to improve PrEP implementation and EHE initiatives. Alternatively, programs employing referral or telehealth models to support the PrEP initiation step can successfully bridge this gap. Disclosures All Authors: No reported disclosures

Loss to Follow-Up and Re-Engagement in HIV Pre-Exposure Prophylaxis Care in the United States, 2013–2019

2021 ◽  
Vol 35 (7) ◽  
pp. 271-277
Author(s):  
Jun Tao ◽  
Madeline C. Montgomery ◽  
Robert Williams ◽  
Prasad Patil ◽  
Brooke G. Rogers ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Loss To Follow Up ◽  
Exposure Prophylaxis

scholarly journals 1292. HIV Pre-Exposure Prophylaxis (PrEP) Implementation at Silom Community Clinic in Bangkok, Thailand, 2016–2018

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S394-S395
Author(s):  
Vanessa Kung ◽  
Sarika Pattanasin ◽  
Chaiwat Ungsedhapand ◽  
Wipas Wimonsate ◽  
Michael Thigpen ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Computer Assisted ◽  
National Guidelines ◽  
Community Clinic ◽  
Voluntary Counseling And Testing ◽  
Counseling And Testing ◽  
Prep Implementation ◽  
Sex With Men ◽  
Exposure Prophylaxis

Abstract Background Since 2014, the Thailand National Guidelines have recommended pre-exposure prophylaxis (PrEP) to prevent HIV among persons at risk. In March 2016, Silom Community Clinic (SCC) began PrEP provision to men who have sex with men (MSM) and transgender women (TGW) in Bangkok, Thailand. Methods SCC staff routinely counseled MSM and TGW attending HIV voluntary counseling and testing about PrEP. If clients believed that they were at substantial risk of HIV and were interested in PrEP, they could receive PrEP after screening that included HIV and renal function testing. Eligible clients received a 30-day supply of daily oral tenofovir-emtricitabine costing 800 Baht (30 USD), and completed a baseline computer-assisted self-interview (CASI) on knowledge and behaviors. At every 3-month follow-up, PrEP clients had a CASI on adherence; if they were interested in discontinuation of PrEP, they completed a CASI that included reasons for discontinuation. We conducted a descriptive analysis of baseline and follow-up CASI results. Results From March 2016 to February 2018, 192 clients were prescribed PrEP, and 80 (42%) continued PrEP for at least 6 months. The median age of clients starting PrEP was 31 years (range, 17–67 years), and 98% were MSM. Overall, most (77%) reported at least 1 of four risk behaviors in the last 3 months; among the 148, 120 (81%) had a sex partner with unknown or positive HIV status, 99 (67%) had anal sex without a condom, 22 (15%) reported an STI, and 16 (11%) received money or goods in exchange for sex. Among the 166 clients who returned for at least one follow-up visit, 135 (81%) completed the CASI at the last follow-up visit; of those, 106 (78%) reported 100% adherence to daily PrEP in the last 7 days, and 126 (93%) reported ≥80% adherence in the last 30 days. Of the 36 clients who discontinued PrEP and completed CASI, 33% reported the reason for discontinuation was no current HIV risk (33%); most (69%) reported that they would consider PrEP in the future. Conclusion Most PrEP users reported adherence to daily PrEP, and almost one half of those starting PrEP continued through month six. PrEP use at SCC is dynamic, and commonly started and stopped based on self-assessed risk. Regular review of PrEP implementation, with a focus on client needs, will optimize use of this prevention approach. Disclosures All authors: No reported disclosures.

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