Integrating HIV Pre-Exposure Prophylaxis into Family Planning Care: A RE-AIM Framework Evaluation.

MedStar author(s):
Citation: AIDS Patient Care & Stds. 34(6):259-266, 2020 06.PMID: 32484743Institution: MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment: Obstetrics and Gynecology | Obstetrics and Gynecology/Family PlanningForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Anti-HIV Agents/ad [Administration & Dosage] | *Delivery of Health Care, Integrated/og [Organization & Administration] | *Family Planning Services/sn [Statistics & Numerical Data] | *HIV Infections/pc [Prevention & Control] | *Mass Screening/sn [Statistics & Numerical Data] | *Pre-Exposure Prophylaxis/mt [Methods] | Adult | Ambulatory Care Facilities | Anti-HIV Agents/tu [Therapeutic Use] | Cohort Studies | Counseling | Family Planning Services/og [Organization & Administration] | Female | HIV Infections/dt [Drug Therapy] | Humans | Prospective Studies | Sex Education | Sexual PartnersYear: 2020ISSN:
  • 1087-2914
Name of journal: AIDS patient care and STDsAbstract: We aimed to systematically evaluate the feasibility of integrating HIV prevention services, including pre-exposure prophylaxis (PrEP), into a family planning setting in a high-prevalence community. We used the RE-AIM Framework (Reach, Efficacy, Adoption, Implementation, Maintenance) to evaluate the integration of HIV prevention services into a family planning clinic over 6 months. Before the integration, PrEP was not offered. We implemented a staff training program on HIV PrEP. We determined the proportion of women presenting to the clinic who were screened, eligible for, and initiated PrEP through chart review. We assessed staff comfort with PrEP pre- and post-integration. We compared planned and actual implementation, interviewed staff to determine barriers and facilitators, and tracked systems adaptations. We assessed maintenance of PrEP after the study concluded. There were 640 clinical encounters for 515 patients; the rate of HIV counseling and PrEP screening was 50%. The rate was 10% in month 1 and peaked to 65% in month 3. Nearly all screened patients were eligible for PrEP (98.4%) and 15 patients (6%) initiated PrEP. Staff knowledge and comfort discussing PrEP improved after education. Facilitators included partnering with local experts, continuing education, clinical tools for providers, and patient education materials. Barriers included competing priorities during clinical encounters, limited woman-centered patient education materials, and insurance-related barriers. Embedding HIV prevention services in the family planning setting was feasible in this pilot. The proportion of women screened for PrEP rapidly increased. In this high HIV prevalence community, nearly all screened women were eligible and 6% initiated PrEP.All authors: Brant AR, Coleman M, Dhillon P, Folan J, Hull S, Lotke PS, Scott RK, Ye PPOriginally published: AIDS Patient Care & Stds. 34(6):259-266, 2020 Jun.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2020-08-26
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Journal Article MedStar Authors Catalog Article 32484743 Available 32484743

We aimed to systematically evaluate the feasibility of integrating HIV prevention services, including pre-exposure prophylaxis (PrEP), into a family planning setting in a high-prevalence community. We used the RE-AIM Framework (Reach, Efficacy, Adoption, Implementation, Maintenance) to evaluate the integration of HIV prevention services into a family planning clinic over 6 months. Before the integration, PrEP was not offered. We implemented a staff training program on HIV PrEP. We determined the proportion of women presenting to the clinic who were screened, eligible for, and initiated PrEP through chart review. We assessed staff comfort with PrEP pre- and post-integration. We compared planned and actual implementation, interviewed staff to determine barriers and facilitators, and tracked systems adaptations. We assessed maintenance of PrEP after the study concluded. There were 640 clinical encounters for 515 patients; the rate of HIV counseling and PrEP screening was 50%. The rate was 10% in month 1 and peaked to 65% in month 3. Nearly all screened patients were eligible for PrEP (98.4%) and 15 patients (6%) initiated PrEP. Staff knowledge and comfort discussing PrEP improved after education. Facilitators included partnering with local experts, continuing education, clinical tools for providers, and patient education materials. Barriers included competing priorities during clinical encounters, limited woman-centered patient education materials, and insurance-related barriers. Embedding HIV prevention services in the family planning setting was feasible in this pilot. The proportion of women screened for PrEP rapidly increased. In this high HIV prevalence community, nearly all screened women were eligible and 6% initiated PrEP.

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