Enhancing HIV Pre-Exposure Prophylaxis Training in Publicly Funded Family Planning Clinics in the Southern United States using an Implementation Science Framework Pubblico
Ramakrishnan, Aditi (Spring 2022)
Published
Abstract
Abstract
Enhancing HIV Pre-Exposure Prophylaxis Training in Publicly Funded Family Planning Clinics in the Southern United States using an Implementation Science Framework
By Aditi Ramakrishnan
Background:
Among women affected by HIV in the United States (US), women in the South are disproportionately affected, but despite this HIV pre-exposure prophylaxis (PrEP) use is markedly low in this population. Training healthcare providers to deliver PrEP and increasing PrEP access are key components of the Ending the HIV Epidemic (EHE) initiative. However, provider training is often not “one size fits all” and may require customization to facilitate successful PrEP implementation in different contexts. Title X-funded family planning (FP) clinics serve as an important safety net source and are ideal sites for expanding PrEP services. In this study, we analyzed associations between PrEP knowledge, attitudes, and self-efficacy (i.e., confidence in conducting the steps of PrEP care) and provider-, clinic-, and county-level variables among providers from Title X-funded FP clinics in the South to inform future customization of provider training.
Methods:
We conducted a secondary analysis of a web-based survey of providers and administrators in Title X FP clinics in 18 Southern states administered February–June 2018. This analysis included providers (clinical staff who could screen, counsel, or prescribe PrEP) from clinics that did not currently provide PrEP. Survey items were designed using the Consolidated Framework for Implementation Research (CFIR). We developed linear mixed models to evaluate the associations between provider-, clinic-, and county-level variables with the CFIR-guided outcomes of provider knowledge, attitudes, and self-efficacy in PrEP care.
Results:
Among 351 providers from 193 unique clinics, 194 (55%) were non-prescribing providers and 157 (45%) were prescribing providers. Provider ability to prescribe medications was associated PrEP knowledge, attitudes, and self-efficacy when adjusting for other provider-, clinic-, and county-level covariates. Self-efficacy was lowest in the PrEP initiation step of overall PrEP care and when stratified by prescriber status. Among all providers, self-efficacy was additionally associated with attitudes, knowledge, contraception self-efficacy, and county Hispanic population, when adjusting for other covariates.
Conclusion:
Our findings suggest that provider PrEP training can be enhanced by customizing training to prescriber status, addressing provider concerns about PrEP, integrating PrEP and existing FP training, and focusing on the initiation steps of PrEP care.
Table of Contents
Introduction………………………………………………………………………………………..1
Background………………………………………………………………………………………...3
Methods……………………………………………………………………………………………..7
Results……………………………………………………………………………………………....13
Discussion……………………………………………………………………………………….....17
References……………………………………………………………………………………….....22
Tables and Figures…………………………………………………………………………......…27
About this Master's Thesis
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