Elissa Z Faro1, Joanne E Mantell2, Tatiana Gonzalez-Argoti3, Susie Hoffman2,4, Zoe Edelstein5, Benjamin Tsoi5, Laurie J Bauman3. 1. Department of Internal Medicine, University of Iowa, Iowa City, IA. 2. Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY. 3. Departments of Pediatrics and Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY. 4. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; and. 5. New York City Department of Health and Mental Hygiene, Queens, NY.
Abstract
BACKGROUND: Uptake of pre-exposure prophylaxis (PrEP) in the US has been limited. Evidence for why and how PrEP has been successfully integrated into some clinical settings, but not in others is minimal. To address this gap, we conducted a qualitative study to identify contextual factors that facilitated and challenged the implementation of PrEP services. SETTING: In partnership with the NYC Department of Health, we convened a planning committee with expertise with groups highly affected by the HIV epidemic employed in diverse health care settings, to guide the project. Representatives from programs within New York were targeted for participation initially and subsequently expanded nationally to enhance diversity in program type. METHODS: Using an interview guide informed by the Consolidated Framework for Implementation Research, we conducted 20 interviews with participants who successfully implemented PrEP programs in different settings (eg, primary care, emergency department, sexual health clinics), using different delivery models. We used template and matrix analysis to identify and characterize contextual determinants and implementation strategies. RESULTS: Participants frequently described determinants and strategies fluidly and conceptualized them in context-specific terms. Commonly discussed Consolidated Framework for Implementation Research constructs included implementation climate (tension for change, compatibility, relatively priority), stakeholders' knowledge (or lack thereof) and beliefs about PrEP, and costs associated with PrEP implementation. CONCLUSION: Our work identifies patterns in PrEP program implementation, describing how organizations dealt with determinants in their own context. Our research points to the need to connect rigorous implementation research with how frontline implementers conceptualize their work to inform and improve PrEP implementation.
BACKGROUND: Uptake of pre-exposure prophylaxis (PrEP) in the US has been limited. Evidence for why and how PrEP has been successfully integrated into some clinical settings, but not in others is minimal. To address this gap, we conducted a qualitative study to identify contextual factors that facilitated and challenged the implementation of PrEP services. SETTING: In partnership with the NYC Department of Health, we convened a planning committee with expertise with groups highly affected by the HIV epidemic employed in diverse health care settings, to guide the project. Representatives from programs within New York were targeted for participation initially and subsequently expanded nationally to enhance diversity in program type. METHODS: Using an interview guide informed by the Consolidated Framework for Implementation Research, we conducted 20 interviews with participants who successfully implemented PrEP programs in different settings (eg, primary care, emergency department, sexual health clinics), using different delivery models. We used template and matrix analysis to identify and characterize contextual determinants and implementation strategies. RESULTS: Participants frequently described determinants and strategies fluidly and conceptualized them in context-specific terms. Commonly discussed Consolidated Framework for Implementation Research constructs included implementation climate (tension for change, compatibility, relatively priority), stakeholders' knowledge (or lack thereof) and beliefs about PrEP, and costs associated with PrEP implementation. CONCLUSION: Our work identifies patterns in PrEP program implementation, describing how organizations dealt with determinants in their own context. Our research points to the need to connect rigorous implementation research with how frontline implementers conceptualize their work to inform and improve PrEP implementation.
Authors: JoAnn E Kirchner; Jeffrey L Smith; Byron J Powell; Thomas J Waltz; Enola K Proctor Journal: Psychiatry Res Date: 2019-07-02 Impact factor: 3.222
Authors: Aaron J Siegler; Farah Mouhanna; Robertino Mera Giler; Kevin Weiss; Elizabeth Pembleton; Jodie Guest; Jeb Jones; Amanda Castel; Howa Yeung; Michael Kramer; Scott McCallister; Patrick S Sullivan Journal: Ann Epidemiol Date: 2018-06-15 Impact factor: 3.797
Authors: Kenneth K Mugwanya; Elizabeth Irungu; Elizabeth Bukusi; Nelly R Mugo; Josephine Odoyo; Elizabeth Wamoni; Kenneth Ngure; Jennifer F Morton; Kathryn Peebles; Sarah Masyuko; Gena Barnabee; Deborah Donnell; Ruanne Barnabas; Jessica Haberer; Gabrielle O'Malley; Jared M Baeten Journal: Implement Sci Date: 2018-09-04 Impact factor: 7.327