Provider Perspectives on HIV Pre-Exposure Prophylaxis Service Disruptions and Adaptations During the COVID-19 Pandemic in Baltimore, Maryland: A Qualitative Study

Rosen, Joseph G.; Zhang, Leanne; Pelaez, Danielle; Coleman, Jenell S.; To, Chi Hung; Cooper, Lyra; Olatunde, Praise F; Toomre, Teagan; Glick, Jennifer L.; Park, Ju Nyeong

doi:10.1089/apc.2022.0058

Cited by 15 publications

(8 citation statements)

References 40 publications

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“…We derived data from the O ptimizing P rEP engagement A mong women L iving in Baltimore City (OPAL) study—a formative, mixed‐methods research study aiming to develop and pilot a work‐force development intervention capacitating frontline harm reduction workers to promote HIV pre‐exposure prophylaxis (PrEP) to PWUD [20]. In the first phase, we facilitated four virtual focus group discussions with 20 HIV and substance use service providers to characterize the PrEP implementation environment for women in Baltimore City.…”

Section: Methodsmentioning

confidence: 99%

Safety in solitude? Competing risks and drivers of solitary drug use among women who inject drugs and implications for overdose detection

et al. 2022

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Background and aims Solitary drug use (SDU) can amplify risks of fatal overdose. We examined competing risks and drivers of SDU, as well as harm reduction strategies implemented during SDU episodes, among women who inject drugs (WWID). Design A cross‐sectional qualitative study, including telephone and face‐to‐face in‐depth interviews. Setting Baltimore City, MD, USA. Participants Twenty‐seven WWID (mean age = 39 years, 67% white, 74% injected drugs daily) recruited via outreach and street intercept (April–September 2021). Measurements Interviews explored the physical (i.e. indoor/private, outdoor/public) and social (i.e. alone, accompanied) risk environments in which drug use occurred. Guided by the principles of emergent design, we used thematic analysis to interrogate textual data, illuminating women's preferences/motivations for SDU and strategies for minimizing overdose risks when using alone. Findings Many participants reported experiences with SDU, despite expressed preferences for accompanied drug use. SDU motivations clustered around three primary drivers: (1) avoiding opioid withdrawal, (2) preferences for privacy when using drugs and (3) safety concerns, including threats of violence. Participants nevertheless acknowledged the dangers of SDU and, at times, took steps to mitigate overdose risk, including naloxone possession, communicating to peers when using alone (‘spotting’) and using drugs in public spaces. Conclusions WWID appear to engage frequently in SDU due to constraints of the physical and social environments in which they use drugs. They express a preference for accompanied drug use in most cases and report implementing strategies to mitigate their overdose risk, especially when using drugs alone.

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Section: Methodsmentioning

confidence: 99%

Safety in solitude? Competing risks and drivers of solitary drug use among women who inject drugs and implications for overdose detection

et al. 2022

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“…PrEP providers across countries broadly agreed on the benefits of differentiated PrEP service delivery and reported particularly positive experiences with community-based approaches, including the use of telehealth, to maintain services during COVID-19. A study in the US found similarly strong support for telehealth models for PrEP delivery, although providers in that study emphasized the need to maintain access to alternatives to telehealth, such as community-based PrEP provision and specimen self-collection, as telehealth may not be suitable for all clients [ 26 ]. This aligns with preferences for easily accessible services expressed by many PrEP clients [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

The Future of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention: A Global Qualitative Consultation on Provider Perspectives on New Products and Differentiated Service Delivery

Henderson¹,

Schmidt

Chitembo

et al. 2023

AIDS Behav

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Differentiated service delivery and new products, such as long-acting injectable cabotegravir (CAB-LA) and the dapivirine vaginal ring (DVR), could increase uptake and use of pre-exposure prophylaxis (PrEP) for HIV prevention. We explored PrEP provider perspectives on differentiated PrEP service delivery and new PrEP products to inform World Health Organization (WHO) guidelines and programme implementation. 150 PrEP providers who participated in a WHO survey were randomly selected and 67 were invited for interviews based on geographic representation, provider cadre, gender, experience with community-based PrEP service delivery, and familiarity with new PrEP products. Semi-structured interviews were conducted virtually. Key themes were inductively extracted relating to differentiated service delivery and benefits and concerns regarding new PrEP products. 30 PrEP providers from 24 countries were interviewed. Across regions, providers were supportive of differentiated service delivery to respond to clients’ needs and preferences, maintain services during COVID-19, and ensure access for priority populations that may face access challenges. Providers welcomed prospects of offering CAB-LA to their clients but had concerns about HIV testing, costs, and the need for clinic-based services, including staff who can administer injections. Providers felt the DVR was potentially important for some cisgender women, especially young clients and female sex workers, and raised fewer concerns compared to injectable PrEP. Providers’ views are critical for the development of guidelines and implementing programmes that will best serve PrEP users. Understanding areas where provider capacities and biases may create barriers can define opportunities for training and support to ensure that providers can deliver effective programmes.

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“…PrEP providers across countries broadly agreed on the bene ts of differentiated PrEP service delivery and reported particularly positive experiences with community-based approaches, including the use of telehealth, to maintain services during COVID-19. A study in the US found similarly strong support for telehealth models for PrEP delivery, although providers in that study emphasized the need to maintain access to alternatives to telehealth, such as community-based PrEP provision and specimen selfcollection, as telehealth may not be suitable for all clients [23].…”

Section: Discussionmentioning

confidence: 99%

The future of pre-exposure prophylaxis (PrEP) for HIV prevention: Provider perspectives

Henderson

Schmidt

Chitembo

et al. 2023

Preprint

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Background: Differentiated service delivery and new products, such as long-acting injectable cabotegravir (CAB-LA) and the dapivirine vaginal ring (DVR), could increase uptake and use of pre-exposure prophylaxis (PrEP) for HIV prevention. We explored PrEP provider perspectives on innovations in service delivery and products to inform World Health Organization (WHO) guidelines and programme implementation. Methods: 150 PrEP providers who participated in a WHO online survey were randomly selected and 67 were invited for interviews based on geographic representation, provider cadre, gender, experience with community-based PrEP service delivery, and familiarity with new PrEP products. Semi-structured interviews were conducted via video calls. Key themes were inductively extracted relating to differentiated service delivery and benefits and concerns regarding new PrEP products. Results: 30 PrEP providers from 24 countries were interviewed. Across regions, providers were supportive of differentiated service delivery to respond to clients’ needs and preferences, maintain services during COVID-19, and ensure access for hard-to-reach populations. Providers welcomed prospects of offering an CAB-LA to their clients but had concerns about HIV testing, costs, and the need for clinic-based services, including staff who can administer injections. Providers felt the DVR was potentially important for some women, especially young clients and female sex workers, and raised fewer concerns compared to injectable PrEP. Conclusions: Providers’ views are critical for the development of guidelines and implementing programmes that will best serve PrEP users. Understanding areas where provider capacities and biases may create barriers can define opportunities for training and support to ensure that providers can deliver effective programmes.

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Provider Perspectives on HIV Pre-Exposure Prophylaxis Service Disruptions and Adaptations During the COVID-19 Pandemic in Baltimore, Maryland: A Qualitative Study

Cited by 15 publications

References 40 publications

Safety in solitude? Competing risks and drivers of solitary drug use among women who inject drugs and implications for overdose detection

Safety in solitude? Competing risks and drivers of solitary drug use among women who inject drugs and implications for overdose detection

The Future of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention: A Global Qualitative Consultation on Provider Perspectives on New Products and Differentiated Service Delivery

The future of pre-exposure prophylaxis (PrEP) for HIV prevention: Provider perspectives

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