Acceptability, Appropriateness, and Preliminary Effects of the PrEP Diffusion Training for Lay HIV Workers: Increased PrEP Knowledge, Decreased Stigma, and Diffusion of Innovation

Abstract

Background Training lay health workers is a critical strategy for HIV pre-exposure prophylaxis (PrEP) implementation, but little is known about effective approaches to conducting and evaluating such trainings. We evaluated the effect of the PrEP Diffusion Training, a one-day participatory training informed by the Diffusion of Innovation theory, on knowledge, PrEP stigma, implementation behavior, and diffusion of PrEP innovation among lay HIV workers in China. Methods Nine PrEP Diffusion Trainings were delivered to 220 lay HIV workers. We conducted multi-timepoint surveys to assess acceptability, appropriateness, and preliminary effects of the training on participants' knowledge, PrEP stigma, determinants of implementation behavior, and diffusion of PrEP information. We used an observation-based checklist to evaluate implementation delity. Results All trainings were delivered with high delity to the standardized manual, with little variability across sites. Acceptability and appropriateness of training were high. PrEP knowledge score signi cantly increased by 65% from pre-training to post-training, and remained high one month after the training. We observed a signi cant decrease in PrEP stigma and a positive in uence on determinants of implementation behaviors. All participants surveyed one-month after the training reported having shared PrEP information in their social networks, and 43% reported integrating PrEP education into their routine HIV prevention work on a regular basis. Conclusions The PrEP Diffusion Training is a practical and effective strategy to build lay HIV workers' capacity to participate in PrEP implementation. Longer-term follow up post training would be ideal to further assess actual PrEP uptake and sustained effects of intervention on PrEP implementation.

An instant messaging mobile phone application for promoting HIV pre-exposure prophylaxis uptake among Chinese gay, bisexual and other men who have sex with men: A mixed methods feasibility and piloting randomized controlled trial study

“…Third, further investigation into how to maximize the benefits of digital technologies in public health intervention for PrEP uptake is warranted. Provider training for both PrEP care provision and digital health-based practice is also critical [ 36 – 38 ]. Lastly, though generic PrEP is already available in China that drastically reduces the financial cost, anticipated stigma or concerns of identity disclosure is consistent throughout our participants’ narratives about PrEP utilization.…”

Moving toward equity: fostering transdisciplinary research between the social and behavioral sciences and implementation science to end the HIV epidemic

“…Process models, which guide translation of research to practice, were not as widely cited as determinant frameworks, perhaps reflecting the nascency of IS in HIV research [2 ▪ ,4 ▪▪ ,5 ▪▪ ]. Studies used process models to prepare for [45 ▪ ,48 ▪▪ ] and evaluate interventions [21 ▪▪ ,40 ▪▪ ], and future application of these theories can guide EBI implementation in real-world settings.…”

“…Gichane et al [22 ▪▪ ] and Garner et al [19 ▪▪ ] provide excellent examples of defining and specifying strategies. Garner et al [19 ▪▪ ] and Wu et al [40 ▪▪ ] also describe robust evaluations of multifaceted implementation strategies.…”

“…For instance, we observed variability in reporting IS TMFs across trials (see Table 3), and only Garner et al [19 ▪▪ ] included Standards for Reporting Implementation Studies [25]. However, we were encouraged to identify numerous protocols describing planned hybrid type 1 [26,27,28 ▪ ,29 ▪ ,30,31], type 2 [32 ▪ ,33,34], and type 3 [35 ▪ ,36,37,38 ▪ ] trials, and completed implementation trials and programs [39,40 ▪▪ ,41 ▪▪ ].…”

“…Addressing a key gap, several studies [21 ▪▪ ,22 ▪▪ ,24 ▪▪ ,41 ▪▪ ,59 ▪▪ ] mapped implementation strategies to the Expert Recommendations for Implementing Change, which established conceptual clarity for 73 strategies [55]. SBS interventions also evaluated implementation strategies using qualitative [22 ▪▪ ,24 ▪▪ ,41 ▪▪ ,59 ▪▪ ] and quantitative methods [19 ▪▪ ,40 ▪▪ ]. Gichane et al [22 ▪▪ ] and Garner et al [19 ▪▪ ] provide excellent examples of defining and specifying strategies.…”