Strengthening PrEP services at community-based organizations for Latinx men who have sex with men: an implementation science approach.

backgroundIn Miami-Dade County Florida (Miami), the rate of newly diagnosed HIV per 100,000 population is four times the national rate with a large majority of transmission due to male-to-male sex. Latinx men are prescribed HIV preventative medication (PrEP) at a lower rate than White individuals; as such, efforts are being made by community health organizations to engage Latinx men who have sex with men (LMSM) in PrEP promotion programs. The objective of this study is to characterize the features, strengths, and weaknesses of the implementation of a PrEP promotion program (DiversiPrEP) at three community based organization (CBO) locations across Miami-Dade and Broward Counties.

methodsAll 30 staff members were invited via e-mail to participate; 11 staff participated in semi-structured interviews were conducted by two authors to assess implementation of the DiversiPrEP program with questions mapped to the Consolidated Framework for Implementation Research (CFIR). We used directed content analysis to analyze qualitative data.

resultsAll staff members self-identified as male and 82% (9 of the 11) identified as Hispanic/Latino. Facilitators to providing PrEP services included: 1) individualized counseling for the PrEP process; 2) providing inviting community-focused spaces with staff who reflect the demographics of the priority population; and 3) hiring non-medical staff that bridge the gap as a translator of both medical and administrative issues. Negative influences on implementation included: 1) federal funding restrictions on lab and testing costs that hinder the ability of the CBO to provide no-cost testing to clients; and 2) finding ways to advertise services to LMSM that may not already be familiar with the CBO.

conclusionsCBO administrative staff provide actionable policy and implementation recommendations for offering culturally tailored PrEP services in other LMSM communities. CBO can reduce PrEP service barriers by acting as intermediaries for navigation of the healthcare system and deferring costs to the clients through federal and state funding programs.