Using qualitative comparative analysis to understand the conditions that produce successful PrEP implementation in family planning clinics.

• Type of Material: Article
• Authors: Kaitlin N. Piper, Emory University; Katherine M. Anderson, Emory University; Caroline W. Kokubun, Emory University; Anandi Sheth, Emory University; Jessica Sales, Emory University
• Language: English
• Date: 2023-06-09
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s43058-023-00450-2
• Title of Journal or Parent Work: Implement Sci Commun
• Volume: 4
• Issue: 1
• Start Page: 64
• End Page: 64
• Grant/Funding Information: This research was supported by the NIH-funded Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) grant U24HD089880. KP is supported by grants from NIH/NIDA F31DA053005 and R25DA037190. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: Implementation; Family planning; HIV; Pre-exposure prophylaxis (PrEP); Configurational comparative methods
• Research Categories: Biology, Virology; Health Sciences, Health Care Management

Abstract

BACKGROUND: Title X-funded family planning clinics have been identified as optimal sites for delivery of pre-exposure prophylaxis (PrEP) for HIV prevention to U.S. women. However, PrEP has not been widely integrated into family planning services, especially in the Southern U.S., and data suggest there may be significant implementation challenges in this setting. METHODS: To understand contextual factors that are key to successful PrEP implementation in family planning clinics, we conducted in-depth qualitative interviews with key informants from 38 family planning clinics (11 clinics prescribed PrEP and 27 did not). Interviews were guided by constructs from the Consolidated Framework for Implementation Research (CFIR), and qualitative comparative analysis (QCA) was used to uncover the configurations of CFIR factors that led to PrEP implementation. RESULTS: We identified 3 distinct construct configurations, or pathways, that led to successful PrEP implementation: (1) high "Leadership Engagement" AND high "Available Resources"; OR (2) high "Leadership Engagement" AND NOT located in the Southeast region; OR (3) high "Access to Knowledge and Information" AND NOT located in the Southeast region. Additionally, there were 2 solution paths that led to absence of PrEP implementation: (1) low "Access to Knowledge and Information" AND low "Leadership Engagement"; OR (2) low "Available Resources" AND high "External Partnerships". DISCUSSION: We identified the most salient combinations of co-occurring organizational barriers or facilitators associated with PrEP implementation across Title X clinics in the Southern U.S. We discuss implementation strategies to promote pathways that led to implementation success, as well as strategies to overcome pathways to implementation failure. Notably, we identified regional differences in the pathways that led to PrEP implementation, with Southeastern clinics facing the most obstacles to implementation, specifically substantial resource constraints. Identifying implementation pathways is an important first step for packaging multiple implementation strategies that could be employed by state-level Title X grantees to help scale up PrEP.