Using Rapid Qualitative Analysis to Assess PrEP Implementation Strategies in Title X Family Planning Clinics within Metro Atlanta 公开
Cortes, Elora (Spring 2024)
Abstract
Background: Over half of all new Human Immunodeficiency Virus (HIV) diagnoses occur in the Southern United States (US). Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention method that is underutilized by those at risk for HIV in the South. PrEP underutilization is pronounced among women, who represent a small percentage of PrEP users in the South. Title X Family Planning (FP) clinics are funded by Georgia Family Planning System (GFPS) to provide sexual and reproductive services, including HIV testing and PrEP counseling. However, Title X FP clinics in the South experience barriers to adopting evidence-based practices (EBPs) that involve PrEP care delivery. GFPS has deployed tailored PrEP implementation strategies in the form of trainings/technical assistance (TA)/resources with the expectation that clinics will adopt and implement PrEP.
There is a need to conduct ongoing assessments to ensure these PrEP trainings/TA/resources are optimized to meet the needs of Atlanta Title X FP clinics. Rapid Qualitative Analysis (RQA) is one potential strategy to generate actionable results from qualitative data in a timely fashion. The purpose of this study was to describe and assess RQA as a strategy to inform PrEP implementation strategies in Atlanta Title X FP clinics.
Methods: RQA was used to analyze existing data. Title X FP clinics had been recruited at the annual Ending the HIV Epidemic (EHE) conference hosted by Georgia Family Planning Services (GFPS) in 2022. Qualitative data from 9 focus group discussions (FGDs) among clinical administrators in Title X FP clinics across Metropolitan (Metro) Atlanta were collected one year after their anniversary date of recruitment (baseline). Each FGD was recorded, transcribed, and de-identified.
Results: Relevant quotes from each clinic extracted from FGD transcripts, were organized into a matrix that was sorted by questions from the FGD interview guide. Quotes were observed for patterns in each key domain from the interview guide using rapid thematic analysis. Lastly, a narrative summary was drafted to further conceptualize major themes emerging across focus groups.
Discussion: Due to the potential need to further tailor and adapt PrEP trainings/TA/resources to meet the evolving needs of Atlanta Title X FP clinics, RQA was used to produce actionable results that will inform potential changes to these strategies. RQA was found to be quick, cost-efficient, and able to produce outputs that respond to the community’s needs. If Title X FP clinics update their PrEP care delivery system due to this project’s findings, it is expected that cisgender women, especially women of color, will benefit from improved services.
Table of Contents
INTRODUCTION........................................................................................................................................ 1
Problem Statement..................................................................................................................................4
Statement of Purpose..............................................................................................................................4
Objectives/Aims.......................................................................................................................................5
Significance..............................................................................................................................................5
Definition of Terms.................................................................................................................................6
LITERATURE REVIEW............................................................................................................................. 8
METHODS................................................................................................................................................. 16
Study Design..........................................................................................................................................16
Geographical Context...........................................................................................................................17
Study Population...................................................................................................................................17
Focus Group Discussions......................................................................................................................18
Procedures.............................................................................................................................................21
Institutional Review Board (IRB) Approval ......................................................................................22
RESULTS................................................................................................................................................... 22
Step 1: Formatted Data Transcripts ...................................................................................................22
Steps 2 and 3: Annual FGD Matrix.....................................................................................................23
Step 4: Summaries using Rapid Thematic Analysis ..........................................................................30
Step 5: Draft Narrative Summary.......................................................................................................37
DISCUSSION............................................................................................................................................. 42
Limitations.............................................................................................................................................44
PUBLIC HEALTH IMPLICATIONS AND RECOMMENDATIONS ................................................... 45
Public Health Implications...................................................................................................................45
Recommendations.................................................................................................................................46
Conclusion .............................................................................................................................................47
REFERENCES .......................................................................................................................................... 48
APPENDICIES.......................................................................................................................................... 55
A. Interview Guide................................................................................................................................55
B. Annual Summaries...........................................................................................................................58
C. Annual FGD Matrix.........................................................................................................................70
About this Master's Thesis
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