Pre-exposure Prophylaxis Implementation in Family Planning Services Across the Southern United States: Findings from a Survey Among Staff, Providers and Administrators Working in Title X-Funded Clinics

Sales, jessica; Escoffery, Cam; Hussen, Sophia A.; Haddad, Lisa; McCumber, Micah; Kwiatkowski, Evan; Filipowicz, Teresa; Sanchez, Maria; Psioda, Matthew A.; Sheth, Anandi N.

doi:10.1007/s10461-020-03120-9

Cited by 17 publications

(20 citation statements)

References 43 publications

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“…This opinion was also reflected among family support workers. Reluctance in prescribing PrEP coupled with bias in PrEP prescribing has been noted among health care providers in previous studies [35][36][37]. There is a need to ensure that Black cisgender women are linked to the adequate resources they need to obtain PrEP.…”

Section: Discussionmentioning

confidence: 99%

Let Me Prep You to PREP Me: Amplifying the Voices of Black Women and Their Providers to Consider PrEP as an HIV Prevention Option

Chandler

Guillaume

Wells

et al. 2022

IJERPH

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Despite the high efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV acquisition, PrEP uptake among Black cisgender women remains low. Our qualitative study assessed Black cisgender women’s perspectives, attitudes, and acceptability towards PrEP, in addition to exploring PrEP-related attitudes, facilitators, and barriers to PrEP access among health care staff. This study was conducted to ascertain data to inform the development of our HIV prevention app—Savvy HER—which is being designed for Black cisgender women. Our findings indicated that Black women had low levels of PrEP acceptability and high levels of misconceptions, inaccurate knowledge, and stigma towards PrEP. Health care providers in our sample confirmed barriers of stigma, misconceptions, and knowledge among their patients coupled with difficulty accessing PrEP due to structural barriers. Our study indicated that there is a critical need to heighten Black cisgender women’s PrEP knowledge and HIV risk perception in order to increase PrEP acceptability and uptake.

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Section: Discussionmentioning

confidence: 99%

Let Me Prep You to PREP Me: Amplifying the Voices of Black Women and Their Providers to Consider PrEP as an HIV Prevention Option

Chandler

Guillaume

Wells

et al. 2022

IJERPH

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“…Surveys completed by respondents outside of the designated Title X DHHS regions were excluded (13 of 755), and only surveys in which the participant responded to the question of PrEP use in the clinic were included ( n = 519). As part of evaluating clinic readiness to implement PrEP [ 14 ], the parent survey addressed various CFIR domains including Characteristics of Individuals, which comprised the constructs of provider knowledge, attitudes, and self-efficacy in PrEP care. The parent survey was created so that only respondents from non-PrEP providing clinics completed certain survey items; therefore, only non-PrEP providing clinic providers (defined as any clinical staff who could screen, counsel, or prescribe PrEP) were included in this analysis.…”

Section: Methodsmentioning

confidence: 99%

“…However, few US PrEP implementation studies have focused on provider training needs [ 8 ] or considered women's health providers [ 9 ], who face key challenges to scaling PrEP. Structural barriers include low risk-perception and awareness of PrEP among women [ 10–13 ] and scarcity of PrEP-providing clinics and insurance support for PrEP, particularly in the South [ 5 , 14 , 15 ]. Provider-level barriers include variable knowledge and attitudes towards PrEP among primary care providers, HIV clinicians, and family planning (FP) providers [ 16–19 ].…”

Section: Introductionmentioning

confidence: 99%

“…Within the CFIR domain, “Characteristics of Individuals,” 3 key constructs relevant to PrEP training include the following: knowledge about PrEP, attitudes towards PrEP, and self-efficacy in PrEP care (ie, confidence in conducting the steps of PrEP care). The Title X Family Planning Program provides funding to support a diverse network of clinics that serve as a safety net source of healthcare for women, particularly in areas without Medicaid expansion [ 14 ], and are potential PrEP delivery sites. The diversity of Title X-funded clinics may lead to variable models of PrEP care [ 22 ], thus tailoring trainings based on assessment of these CFIR constructs may be particularly relevant for PrEP scale-up in this setting.…”

Section: Introductionmentioning

confidence: 99%

“…We recently conducted a CFIR-guided survey of providers and administrators from Title X clinics in the South to systematically study facilitators and barriers to implementation of PrEP in this setting [ 14 ]. In this secondary analysis of the parent survey, our objectives are to assess the associations between provider-, clinic-, and county-level covariates, and the CFIR constructs of provider knowledge, attitudes, and self-efficacy in PrEP care, with the overall goal of informing how to tailor PrEP training for FP providers in the Southern United States.…”

Section: Introductionmentioning

confidence: 99%

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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

Ramakrishnan

Sales

McCumber

et al. 2022

Open Forum Infectious Diseases

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Background PrEP is an effective HIV prevention intervention, but its access and use are suboptimal, especially for women. Healthcare providers provision of PrEP is a key component of the Ending the HIV Epidemic initiative. Though training gaps are an identified barrier, evidence is lacking regarding how to tailor trainings for successful implementation. Title X family planning clinics deliver safety net care for women and are potential PrEP delivery sites. To inform provider training, we assessed PrEP knowledge, attitudes, and self-efficacy in the steps of PrEP care among Title X providers in the Southern US. Methods We used data from providers in clinics that did not currently provide PrEP from a web-based survey administered to Title X clinic staff in 18 Southern states from February-June 2018. We developed generalized linear mixed models to evaluate associations between provider-, clinic-, and county-level variables with provider knowledge, attitudes, and self-efficacy in PrEP care, guided by the Consolidated Framework for Implementation Research. Results Among 351 providers from 193 clinics, 194 (55%) were non-prescribing and 157 (45%) were prescribing providers. Provider ability to prescribe medications was significantly associated PrEP knowledge, attitudes, and self-efficacy. Self-efficacy was lowest in the PrEP initiation step of PrEP care and was positively associated with PrEP attitudes, PrEP knowledge, and contraception self-efficacy. Conclusion Our findings suggest that PrEP training gaps for family planning providers may be bridged by addressing unfavorable PrEP attitudes, integrating PrEP and contraception training, tailoring training by prescribing ability, and focusing on the initiation steps of PrEP care.

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Primary Care and Pre-exposure Prophylaxis Services in Publicly Funded Family Planning Clinics in the Southern United States

et al. 2021

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BACKGROUND: HIV pre-exposure prophylaxis (PrEP) is underutilized by US women. Cost and resource concerns are barriers to PrEP delivery in settings that see men. Family planning clinics may be ideal PrEP delivery settings for women, but as they are not uniform in their clinical services, cost and resource concerns may vary. OBJECTIVE: We examined factors that influence perceptions of costs and resources related to PrEP delivery in Title X-funded family planning clinics in Southern states, which overlaps with high HIV-burden areas. DESIGN: We conducted a web-based survey among a convenience sample of clinicians and administrators of Title X clinics across 18 Southern states (DHHS regions III, IV, VI). We compared cost-and resource-related survey items and other clinic-and county-level variables between clinics by whether their clinics also provided other primary care services. We analyzed interviews for cost and resource themes. PARTICIPANTS: Title X clinic staff in the South. KEY RESULTS: Among 283 unique clinics, a greater proportion of clinics that also provided primary care currently provided PrEP compared with those that did not provide primary care (27.8% vs. 18.3%, p = 0.06), but this difference was not statistically significant. Among 414 respondents in clinics that were not providing PrEP, those in clinics with primary care services were more likely to respond that they had the necessary financial resources (p < 0.01) and staffing (p < 0.01) for PrEP implementation compared to those without primary care services. In interviews, respondents differed on concerns about costs of labs and staffing based on whether their clinic had concomitant primary care services or not. CONCLUSIONS: Among publicly funded Southern family planning clinics, current PrEP provision was higher among clinics with concomitant primary care. Among clinics not providing PrEP, those with concomitant primary care services have lower perceived cost and resource barriers and therefore may be optimal for expanding PrEP among women.

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Pre-exposure Prophylaxis Implementation in Family Planning Services Across the Southern United States: Findings from a Survey Among Staff, Providers and Administrators Working in Title X-Funded Clinics

Cited by 17 publications

References 43 publications

Let Me Prep You to PREP Me: Amplifying the Voices of Black Women and Their Providers to Consider PrEP as an HIV Prevention Option

Let Me Prep You to PREP Me: Amplifying the Voices of Black Women and Their Providers to Consider PrEP as an HIV Prevention Option

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

Primary Care and Pre-exposure Prophylaxis Services in Publicly Funded Family Planning Clinics in the Southern United States

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