HIV Community-Based Organizations' Readiness and Self-Perceptions Regarding Their Role in PrEP Implementation Open Access

Maier, Emily (2016)

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Introduction: Community-based organizations (CBOs) are essential in the prevention of HIV. As pre-exposure prophylaxis (PrEP) becomes increasingly accepted and advocated for by international agencies, the role of implementation will fall largely to local organizations. It is necessary to understand the current state of CBOs' readiness to utilize and advocate PrEP, and assess knowledge, attitudes, and practices regarding such. The purpose of this study was to gauge contemporary PrEP implementation as well as measure CBOs' self-perceptions regarding their role for PrEP scale-up. A secondary goal of the study was to determine important factors associated with CBOs' awareness and intentions regarding PrEP.

Methods: In February and March 2015, an online national survey was conducted by the Division of HIV/AIDS Prevention of the Centers for Disease Control and Prevention. Managers and direct service providers from each CBO were surveyed regarding organizational characteristics, PrEP awareness, resource needs, and challenges regarding implementation of biomedical interventions. A PrEP Readiness Score (PRS) was assigned to each CBO based on the services provided, as reported by the first manager. Organizational characteristics were compared across PRS levels. Bivariate associations between organizational variables and PrEP-associated outcomes were assessed, and those that were significant were eligible to compete in the final multivariate logistic model.

Results: 232 of the 424 CBOs responded. Organizations differed by PRS on percentage of clienteles that were men who have sex with men and heterosexual females, as well as the percentage of the annual budget that was from private sources. Organizations greatly differed by PRS with respect to services provided. Higher PRS CBOs were more aware and currently provided PrEP; although the majority of organizations reported an interest in provided PrEP, given more resources. PRS was found to be a significant predictor of PrEP awareness (OR=5.683 per index increase, 95% CI = 1.412, 22.875), clients requesting information about PrEP [OR=2.160 per index increase, CI = 1.061, 4.397], and CBOs prescribing PrEP [OR=4.722 per index increase, CI = 2.267, 9.837].

Conclusion: Our findings indicate a need to increase information, training and resources of CBOs in order to scale-up implementation of PrEP to reduce HIV transmission.

Table of Contents

Introduction. 1

Methods. 6

Survey Design. 6

Analysis. 7

Modeling. 10

Eligibility Criteria. 10

Pilot Test 11

Data Collection. 11

Results. 12

PrEP Readiness Score. 12

Characteristics. 12

Awareness, Attitudes, Intentions. 14

Modeled Correlation between PrEP Readiness and CBO Characteristics. 15

Resource Priorities. 17

Discussion. 17

Conclusion. 20

References. 21

Tables. 25

Table 1. Organizational Characteristics of Respondent Community Based HIV Prevention Organizations as Reported by Program Managers (n=175 CBOs), 2015. 25

Table 2. Awareness, Attitude, Intentions as Reported by Program Managers (n=175 CBOs). 28

Table 3. Regression Analysis of CBO patient demographics with PrEP Awareness: bivariate associations, multivariate associations, and stepwise regression. 29

Table 4. Regression Analysis of CBO demographics with Clients Requesting Information about PrEP in the last year: bivariate associations, multivariate associations, and stepwise regression. 30

Table 5. Regression Analysis of CBO demographics with Prescription of PrEP in the last year: bivariate associations, multivariate associations, and stepwise regression. 31

Table 6. Regression Analysis of CBO demographics with Intention regarding PrEP (dichotomized): bivariate associations, multivariate associations, and stepwise regression. 32

Table 7. Resource Priorities of CBOs as as Reported by Program Managers (n=175 CBOs). 33

Appendix. 35

Biomedical HIV Prevention Organizational Assessment Survey. 35

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