Determinants of Implementation for HIV Pre-exposure Prophylaxis Based on an Updated Consolidated Framework for Implementation Research: A Systematic Review

Abstract

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Human Immunodeficiency Virus Pre-Exposure Prophylaxis Knowledge, Attitudes, and Self-Efficacy Among Family Planning Providers in the Southern United States: Bridging the Gap in Provider Training

“…Third, this analysis focused on the provider-level outcomes within the CFIR domain, Characteristics of Individuals, and was conducted only in non-PrEP clinics. Previous work from our group and others have shown numerous CFIR constructs relevant to PrEP implementation [ 14 , 43 ], including inner and outer setting factors that were not assessed in this analysis. Additional work is needed to examine provider-level and other successful pathways for PrEP implementation, including within clinics that already provide PrEP.…”

High interest in Long-Acting Injectable PrEP among Filipina Transfeminine Adults

“…Even fewer participants (39%) had ever discussed PrEP with their friends. Social communication about PrEP has proven to be a challenge in many settings due to PrEP-related stigma in many parts of the world [8]. For example, studies have suggested some of the judgmental beliefs attributed to people interested in PrEP – e.g., beliefs that equate PrEP with promiscuity, risk-taking, shame [41, 42].…”

“…While transfeminine adults in our sample showed high interest in taking LAI-PrEP, it is necessary for future studies aiming to inform PrEP implementation strategies to ascertain what transfeminine adults know about LAI-PrEP, including attitudes and beliefs about LAI-PrEP and how to best deliver it to their communities and social groups [8]. This includes understanding key health communication strategies such as efficacy messaging and framings about LAI-PrEP that resonate with other health priorities among communities of transfeminine adults such as access to hormones and gender-inclusive providers [47].…”

“…The emerging literature of implementation science, as applied within the field of biomedical HIV prevention [7,8], emphasizes the need for a critical, formative understanding of multiple determinants across the socio-ecological (e.g., personal, social, community, structural) levels that can guide implementation of LAI-PrEP. In a systematic review synthesizing determinants of PrEP implementation [8], frequent barriers included factors across socio-ecological levels: (a) at the personal level -lack of PrEP awareness and knowledge, adherence challenges to daily medication over time, and concerns about side effects and interactions with other medications such as gender-affirming hormones [9][10][11][12]; (b) at the interpersonal level -discomfort talking to providers about PrEP, provider's lack of knowledge or support of PrEP, and having mistrust of providers [13][14][15]; (c) at the social level -lack of partner support for taking PrEP, and lack of communication about health issues and PrEP among community members [14,16,17], including PrEP discussion among trans friends and providers [15]; and (d) at the structural level -having segregated or fragmented health care systems, concern about paying for PrEP including out-ofpocket costs for necessary labs and visit copays, frequency of required clinic visits, stigma and discriminatory practices and policies related to PrEP, HIV, transgender identity, and sexual behavior, as well structural determinants such as poverty, unemployment, unstable housing [14,[16][17][18][19]. Moreover, while the Philippines is considered one of the most socially tolerant countries for lesbian, gay, bisexual, and transgender (LGBT) people compared to other neighboring countries in the Southeast Asian region [20], its policies and laws continue to reflect transphobia, sexual conservatism, and highly influenced by pervasive religious fundamentalist hegemony [21][22][23], with 81% of the country's population being affiliated with Catholicism [24].…”

Implementation Barriers and Experiences of Eligible Patients Who Failed to Enroll in Collaborative Care for Depression and Anxiety

“…They first co-coded eight transcripts to become familiar with the coding constructs which were discussed with a third team member (JDS), who is experienced in using CFIR 2.0 for qualitative coding. 40 The two authors then independently coded 18 and 19 transcripts each and convened to check all codes, discuss questions that arose, and collaboratively determine the final code. Coding was confirmed by a third researcher (JDS), and any disagreements were discussed prior to finalizing the codes.…”