Pre-exposure prophylaxis integration into family planning services at title x clinics in the southeastern united states: Protocol for a mixed methods hybrid type i effectiveness implementation study (phase 2 atn 155)

• Type of Material: Article
• Authors: Anandi Sheth, Emory University; Sophia Hussen, Emory University; Ngoc-Cam Escoffery, Emory University; Lisa Haddad, Emory University; Leah Powell, Emory University; Nakita Brown, Emory University; Teresa R. Filipowicz, University of North Carolina; Micah McCumber, University of North Carolina; Maria Sanchez, University of North Carolina; Laura Renshaw, University of North Carolina; Matthew A. Psioda, University of North Carolina; Jessica Sales, Emory University
• Language: English
• Date: 2020-09-01
• Publisher: JMIR
• Publication Version: Final Published Version
• Copyright Statement: ©Anandi N Sheth, Sophia A Hussen, Cam Escoffery, Lisa B Haddad, Leah Powell, Nakita Brown, Teresa R Filipowicz, Micah McCumber, Maria Sanchez, Laura Renshaw, Matthew A Psioda, Jessica M Sales. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 25.09.2020.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.2196/18784
• Title of Journal or Parent Work: JMIR Research Protocols
• Volume: 9
• Issue: 9
• Start Page: e18784
• End Page: e18784
• Grant/Funding Information: The ATN is funded by the National Institutes of Health through the Eunice Kennedy Shriver National Institute of Child Health and Human Development with supplemental funding from the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institute on Minority Health and Health Disparities. This research was supported by the National Institutes of Health grant 5U24HD089880. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: HIV; family planning services; implementation science; pre-exposure prophylaxis
• Research Categories: Health Sciences, Public Health; Biology, Virology

Abstract

Background: Adolescent and young adult women (AYAW), particularly racial and ethnic minorities, in the Southern United States are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is an effective, scalable, individual-controlled HIV prevention strategy that is grossly underutilized among women of all ages and requires innovative delivery approaches to optimize its benefit. Anchoring PrEP delivery to family planning (FP) services that AYAW already trust, access routinely, and deem useful for their sexual health may offer an ideal opportunity to reach women at risk for HIV and to enhance their PrEP uptake and adherence. However, PrEP has not been widely integrated into FP services, including Title X-funded FP clinics that provide safety net sources of care for AYAW. To overcome potential implementation challenges for AYAW, Title X clinics in the Southern United States are uniquely positioned to be focal sites for conceptually informed and thoroughly evaluated PrEP implementation science studies. Objective: The objective of this study is two-fold: To evaluate multilevel factors associated with the level of PrEP adoption and implementation (eg, PrEP screening, counseling, and prescription) within and across 3 FP clinics and to evaluate PrEP uptake, persistence, and adherence among female patients in these clinics over a 6-month follow-up period. Methods: Phase 2 of Planning4PrEP (Adolescent Medicine Trials Network for HIV/AIDS Interventions 155) is a mixed methods hybrid type 1 effectiveness implementation study to be conducted in three clinics in Metro Atlanta, Georgia, United States. Guided by the Exploration, Preparation, Implementation, and Sustainment framework, this study will prepare clinics for PrEP integration via clinic-wide trainings and technical assistance and will develop clinic-specific PrEP implementation plans. We will monitor and evaluate PrEP implementation as well as female patient PrEP uptake, persistence, and adherence over a 6-month follow-up period. Results: Phase 2 of Planning4PrEP research activities began in February 2018 and are ongoing. Qualitative data analysis is scheduled to begin in Fall 2020. Conclusions: This study seeks to evaluate factors associated with the level of PrEP adoption and implementation (eg, PrEP screening, counseling, and prescription) within and across 3 FP clinics following training and implementation planning and to evaluate PrEP uptake, persistence, and adherence among female patients over a 6-month follow-up period. This will guide future strategies to support PrEP integration in Title X-funded clinics across the Southern United States.