Facilitators, Barriers, and Opportunities to Implementing Sexual History Screening and Human Immunodeficiency Virus Pre-Exposure Prophylaxis at a Federally Qualified Health Center. AIDS Patient Care STDS 2024 May;38(5):230-237
Date
04/26/2024Pubmed ID
38669122Pubmed Central ID
PMC11386997DOI
10.1089/apc.2024.0026Scopus ID
2-s2.0-85192228638 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
Sexual history screening (SHS) is recommended to determine risk for acquisition of human immunodeficiency virus (HIV) and eligibility for pre-exposure prophylaxis (PrEP). SHS and PrEP are underutilized, sequential screening, and prevention practices. This study aimed to understand factors impacting the implementation of SHS and PrEP at a multi-site federally qualified health center (FQHC) in Connecticut. Guided by the Consolidated Framework for Implementation Research, semistructured interviews were conducted on Zoom with primary care providers (PCPs), medical assistants, clinical leadership, and PrEP navigators. Convenience and purposive sampling took place via email until thematic saturation was achieved. Thematic analysis was conducted. Twenty-two participants were interviewed for this study. PCPs lacked knowledge and reported limited or no use of SHS to determine patients' level of HIV risk, which may explain why most PCPs relied on patients to request PrEP. While PCPs perceived organizational support to prescribe PrEP, clinical staff were unaware of structural resources. Lastly, participants described a vertical trajectory of influence from external sources (policies and insurance) to time allocated to appointments that limits their ability to implement SHS and PrEP, further complicated by the electronic health record and disparities in structural resources across clinical sites. This study provides foundational evidence for future research on implementation strategies to improve HIV prevention through universal, comprehensive SHS to identify patients for PrEP. Overcoming barriers to SHS and PrEP, particularly in clinical settings such as FQHCs that care for vulnerable populations, may improve identification, prevention, and treatment of HIV and aid in ending the HIV epidemic.
Author List
Gagnon KW, Coulter RWS, Egan JE, Ho K, Hawk MAuthor
Kelly W. Gagnon PhD Assistant Professor in the Psychiatry and Behavioral Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAnti-HIV Agents
Attitude of Health Personnel
Connecticut
Female
HIV Infections
Health Knowledge, Attitudes, Practice
Health Services Accessibility
Humans
Interviews as Topic
Male
Mass Screening
Medical History Taking
Middle Aged
Pre-Exposure Prophylaxis
Primary Health Care
Qualitative Research
Sexual Behavior
