Implementation of an Educational Intervention to Improve HIV Pre-Exposure Prophylaxis Services for Women in an Urban Sexual Health Clinic

Rachel K Scott; Megan Deyarmond; Shannon Marwitz; Jim C Huang; Patricia Moriarty; Adam J Visconti; Jason Beverley; Rick Elion; Megan Coleman; Shawnika J Hull

doi:10.1089/apc.2023.0107

Implementation of an Educational Intervention to Improve HIV Pre-Exposure Prophylaxis Services for Women in an Urban Sexual Health Clinic

AIDS Patient Care STDS. 2023 Sep;37(9):447-457. doi: 10.1089/apc.2023.0107.

Authors

Affiliations

¹ Department of Women's and Infants' Services, MedStar Washington Hospital Center, Division of Women's Health Research, MedStar Health Research Institute, Washington, District of Columbia, USA.
² Georgetown University School of Medicine, Washington, District of Columbia, USA.
³ Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan.
⁴ Division of Women's Health Research, MedStar Health Research Institute, Washington, District of Columbia, USA.
⁵ HIV/AIDS, Hepatitis, STD and TB Administration, DC Health, Washington, District of Columbia, USA.
⁶ Whitman Walker Health, Washington, District of Columbia, USA.
⁷ Department of Prevention and Community Medicine, George Washington University, Washington, District of Columbia, USA.

PMID: 37713289
PMCID: PMC10623070 (available on 2024-09-01)
DOI: 10.1089/apc.2023.0107

Abstract

To test the hypothesis that implementation of a multicomponent, educational HIV pre-exposure prophylaxis (PrEP) intervention to promote universal PrEP services for cisgender women (subsequently "women") in sexual and reproductive health centers would improve the proportion of women screened, offered, and prescribed PrEP, we implemented a multicomponent, educational intervention in a Washington D.C. Department of Health-sponsored sexual health clinic. The clinic serves a patient population with high-potential exposure to HIV. The intervention included clinic-wide PrEP trainings, an electronic health record prompt for PrEP counseling by providers, and educational videos in the waiting room. We collected preimplementation data from March 22, 2018 to July 4, 2018, including 331 clinical encounters for 329 women. Between July 5, 2018 and July 1, 2019, there were 1733 clinical encounters for 1720 HIV-negative women. We used mixed methods to systematically assess intervention implementation using the Reach Effectiveness Adoption Implementation Maintenance framework. Additionally, we assessed the interventions' acceptability and feasibility among providers through semistructured interviews. The proportion of women screened by providers for PrEP (5.6% preimplementation to a mean of 89.2% of women during the implementation period, p < 0.01), offered (6.2 to 69.8%, p < 0.01), and prescribed PrEP (2.6 to 8.1%, p < 0.01) by providers increased significantly in the implementation period. Providers and clinic staff found the intervention both highly feasible and acceptable and demonstrated increased knowledge of PrEP and HIV prevention associated with the clinic-wide trainings. Our results demonstrate the effectiveness of a low-cost educational intervention to increase provision of integrated PrEP services in an urban sexual health clinic serving women with high-potential exposure to HIV. ClinicalTrials.gov ID NCT03705663.

Keywords: HIV infections/prevention and control; PrEP; PrEP cascade; RE-AIM; anti-HIV agents; females; health services accessibility; implementation science; pre-exposure prophylaxis.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Ambulatory Care Facilities
Educational Status
HIV Infections* / prevention & control
Humans
Pre-Exposure Prophylaxis*
Sexual Health*

Associated data

ClinicalTrials.gov/NCT03705663

Grants and funding

K01 DA050496/DA/NIDA NIH HHS/United States