Exploring PrEP Implementation Factors in the Southern US

In the Southern United States, there is a low availability of PrEP-providing clinics, and little is known about the factors which influence PrEP implementation in this region, due to the varying state-level policies.

Recently, investigators from the Emory University School of Medicine, in collaboration with the University of North Carolina at Chapel Hill, sought to explore the state-level clustering of organizational constructs relevant to PrEP implementation in family planning clinics within the Southern US.

The data was presented at the 11th International AIDS Society Conference on HIV Science.

For the study, the team of investigators conducted surveys of providers and administrators at publicly-funded family planning clinics who did not provide PrEP in 18 states between February and June of 2019.

A Consolidated Framework for Implementation Research (CFIR) was used to inform construct selection, which included the readiness to implement PrEP and others previously associated with PrEP readiness.

A linear mixed model with fixed effects for state, provider, and clinic-level covariates, and a random effect for clinic was also used to analyze each construct.

Findings from the study showed that clusters 1 and 2 were separated from cluster 3 by PrEP readiness, HIV-specific implementation climate, PrEP-specific leadership engagement, PrEP attitudes, PrEP knowledge, and general resource availability.

Cluster 2 was distinguished from cluster 1 by PrEP-specific resource availability, PrEP attitudes, and general implementation climate. Additionally, all states in cluster 3 had expanded Medicaid when compared to 1 state in cluster 1 and none in cluster 2.

“CFIR constructs relevant for PrEP implementation exhibited state-level clustering, suggesting that tailored strategies could be used by clustered states to improve PrEP provision in FP clinics,” the authors wrote. “Medicaid expansion was a common feature in states within C3, which could explain the similarity of their implementation constructs. The role of Medicaid expansion and state-level policies on PrEP implementation warrants further exploration.”