AIDS and behavior · 2025
Barriers to Same-Day Pre-exposure Prophylaxis (PrEP) Implementation in Federally Funded HIV Clinics Within High-Burden Areas of the U.S.: A Coincidence Analysis.
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Zamantakis Alithia, Gomez Wilson, Lukose Lipin, Pachicano Ana Michaela, Kassanits Jessica, Katomski Anna-Sophia, Rosenberg-Carlson Elena P, Willging Cathleen E, Nelson LaRon E, Valeriano Tequetta, Karris Maile, Blumenthal Jill S, Rana Aadia I, Brewer Russell A, Hamilton Alison, Kemp Christopher, Humphries Debbie, Benbow Nanette D, Kao Uyen, Lee Sung-Jae, Jones Joyce L, Schwartz Sheree R, Beres Laura K, Rosen Joseph G
Аннотация
BACKGROUND: Same-day pre-exposure prophylaxis (PrEP) for HIV prevention is a novel tool to increase biomedical prevention access and uptake. Although prior research has identified same-day PrEP as feasible and acceptable, improved understanding of key barriers and facilitators to implementation is needed to optimize impact.
METHODS: The Network for Implementation Science in HIV (NISH) examined the implementation of same-day PrEP across 42 Ryan White Part A-D-funded organizations in seven Ending the U.S. HIV Epidemic Initiative priority jurisdictions. We used crisp-set coincidence analysis with six conditions to identify key barriers explaining delayed implementation of same-day PrEP among 38 clinical organizations representing 137 individual clinics where same-day PrEP services were available currently or in the future.
RESULTS: Our final model explained ~ 67% of clinical organizations not currently implementing same-day PrEP (n = 8), with a consistency of 80%. This model identified three pathways to non-implementation of same-day PrEP: (1) insurance coverage as a top barrier and insufficient staffing resources as a top barrier; (2) no onsite pharmacy as a top barrier; or (3) provider reticence with same-day PrEP prescribing and insurance coverage as top barriers, and patient demand/(dis)interest in same-day PrEP not being ranked as a top barrier.
CONCLUSION: The three identified pathways to delayed implementation of same-day PrEP aid researchers and providers in reverse mapping strategies to enhance and scale up the implementation of same-day PrEP in federally funded clinics in the U.S. Such strategies may include federal and state-level policy changes to expand funding for PrEP coverage, pharmacist-led same-day PrEP implementation, or mail delivery of PrEP prescriptions.
METHODS: The Network for Implementation Science in HIV (NISH) examined the implementation of same-day PrEP across 42 Ryan White Part A-D-funded organizations in seven Ending the U.S. HIV Epidemic Initiative priority jurisdictions. We used crisp-set coincidence analysis with six conditions to identify key barriers explaining delayed implementation of same-day PrEP among 38 clinical organizations representing 137 individual clinics where same-day PrEP services were available currently or in the future.
RESULTS: Our final model explained ~ 67% of clinical organizations not currently implementing same-day PrEP (n = 8), with a consistency of 80%. This model identified three pathways to non-implementation of same-day PrEP: (1) insurance coverage as a top barrier and insufficient staffing resources as a top barrier; (2) no onsite pharmacy as a top barrier; or (3) provider reticence with same-day PrEP prescribing and insurance coverage as top barriers, and patient demand/(dis)interest in same-day PrEP not being ranked as a top barrier.
CONCLUSION: The three identified pathways to delayed implementation of same-day PrEP aid researchers and providers in reverse mapping strategies to enhance and scale up the implementation of same-day PrEP in federally funded clinics in the U.S. Such strategies may include federal and state-level policy changes to expand funding for PrEP coverage, pharmacist-led same-day PrEP implementation, or mail delivery of PrEP prescriptions.