An evaluation of the impact of PrEP provisions on Title X providers' self-efficacy to discuss PrEP with women receiving family planning services in Metro Atlanta Restricted; Files Only
Rogers, Laura (Spring 2026)
Abstract
Background: In the United States, rates of new HIV diagnoses among women continue
to be high, specifically in Metro Atlanta. Pre-exposure prophylaxis (PrEP) is an effective
medication to help reduce the spread of HIV, but it remains underutilized, especially
among women. One proposed solution to increase PrEP use among women is to
implement PrEP services in Title X clinics. However, Title X providers often face barriers
when providing PrEP services to patients, such as lack of knowledge or comfort
regarding PrEP. Trainings for providers have been suggested as a solution to address
these barriers and have shown successful results regarding increased PrEP prescriptions
and provider knowledge at clinics. This study aimed to evaluate the impact PrEP trainings
can have on provider self-efficacy and confidence to discuss PrEP with women who
receive care at Title X clinics in Metro Atlanta.
Methods: Two hundred and one Title X providers from nine clinical groups in Metro
Atlanta participated in PrEP trainings and completed the accompanying evaluation survey
between April of 2022 and June of 2024. HIV testing data was collected through chart
abstraction between 2021 and 2024. Descriptive statistics and t-tests were calculated in
SAS 9.4 and scatterplots were created using Microsoft Excel.
Results: Participants represented various backgrounds including race, ethnicity, and
clinic roles. All three trainings saw an increase in provider self-efficacy scores from
before the trainings to after the trainings. Broken down by clinical groups, all clinical
groups saw an increase in provider self-efficacy scores from before the trainings to after
the trainings, except one clinical group. The difference in mean scores from before and
after the trainings were found to be statistically significant for all three trainings, with all
having a p-value<.0001. A scatterplot comparing the change in provider self-efficacy
scores to the change in HIV tests performed at the clinics found a positive relationship
between the two.
Conclusion: PrEP Trainings for Title X providers have the ability to increase provider
self-efficacy, which may increase more women receiving PrEP services in Metro Atlanta.
PrEP trainings for providers to improve self-efficacy may also be able to increase other
HIV prevention methods in Title X clinics, such as HIV testing. The results from this
study support using provider trainings as a sustainable, capacity-building approach to
increase PrEP services in Title X clinics.
Table of Contents
Table of Contents
Chapter I: Introduction ...................................................................................................... 1
Introduction and Rationale ........................................................................................... 1
Problem ........................................................................................................................... 3
Theoretical Frameworks ............................................................................................... 3
Aim and Research Question ......................................................................................... 4
Significance .................................................................................................................... 5
Definition of Terms ........................................................................................................ 5
Language and Terminology .......................................................................................... 6
People Living with HIV .............................................................................................. 6
“Women” and “Woman” .............................................................................................. 7
Chapter II: Literature Review ............................................................................................ 8
Introduction ................................................................................................................... 8
The Role of Title X Providers and PrEP ................................................................... 11
Bringing PrEP into Title X Clinics ............................................................................ 11
Challenges to Providers Regarding PrEP .................................................................. 14
PrEP Trainings for Providers ..................................................................................... 17
Theoretical Frameworks ............................................................................................. 20
Integrative Behavioral Model (IBM) ......................................................................... 21
Adult Learning Theory .............................................................................................. 24
What This Study Contributes ..................................................................................... 26
Chapter III: Methodology ................................................................................................ 28
Introduction ................................................................................................................. 28
Study Design ................................................................................................................. 29
Sampling and Recruitment ......................................................................................... 29
Measures ....................................................................................................................... 30
Data Collection Procedures ........................................................................................ 31
Data Analysis Methodology ........................................................................................ 32
Chapter IV: Results ........................................................................................................... 35
Introduction ................................................................................................................. 35
Sample .......................................................................................................................... 35
Key Findings ................................................................................................................ 38
Descriptive Statistics for Participant Scores by Training .......................................... 38
Descriptive Statistics for Participant Scores by Training .......................................... 39
Hypothesis Testing .................................................................................................... 41
Additional Findings ..................................................................................................... 42
Chapter V: Discussion ...................................................................................................... 47
Introduction ................................................................................................................. 47
Discussion of Results ................................................................................................... 48
Strengths and Limitations ........................................................................................... 50
Public Health Implications ......................................................................................... 52
Conclusions .................................................................................................................. 54
References ......................................................................................................................... 56
Appendix A: Training Options Menu .............................................................................. 69
Appendix B: Evaluation Surveys ..................................................................................... 70
About this Master's Thesis
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File download under embargo until 21 May 2028 | 2026-04-23 11:10:34 -0400 | File download under embargo until 21 May 2028 |
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