Evaluating an Implementation Strategy Bundle in Title X-Funded Safety-Net Family Planning Clinics to Increase HIV Testing and PrEP Access Among Cis-Gender Women in Atlanta, United States: Lessons Learned From Provider Focus Groups.

introductionPre-exposure prophylaxis (PrEP) remains underutilized by women in the United States, in part because PrEP is not widely available in women's healthcare settings. We developed a bundle of tailored implementation strategies (trainings, technical assistance [TA], resources) to support HIV prevention delivery in Title X-funded family planning clinics across Atlanta, Georgia (GA). Guided by the interactive systems framework, we partnered with GA's largest Title X grant holder to provide these strategies to this network. We conducted an evaluation of clinic strategy use and described pre- and post-strategy engagement HIV prevention/PrEP practices.

methodsUsing a qualitative descriptive design, between January 2022 and November 2023, 47 staff, providers and leadership from 11 clinical groups representing 22 of 31 Atlanta Title X clinics (71%) separately participated in baseline (pre-strategy) focus groups (FGs); 10 groups participated in FGs 1-year post-strategy(s). Rapid qualitative analysis of FGs was performed. Chart-abstracted measures were used to describe clinical group-aggregate HIV testing numbers 1 year prior to and 1 year after implementation strategy engagement.

resultsTwenty-two trainings were provided (n = 358 participants), with two TA and 53 requests received across 11 clinical groups. Clinics reported training and resource implementation strategies were acceptable and helped increase their readiness/capacity to provide PrEP, but scheduling trainings was sometimes challenging. Due to significant staff turnover, many noted that refresher trainings were or would be beneficial. TA was underutilized despite its potential need by clinical groups. At baseline, few clinics (<5; 22%) were providing PrEP. At follow-up, eight clinical groups were offering PrEP; one offered referrals to a PrEP-specific clinic. Three groups were able to provide injectable PrEP; two groups were not offering PrEP consistently or at all. Most groups (8 of 11; 73%) reported increases in total HIV tests in the 12 months after strategy engagement.

conclusionsImplementation strategies were utilized by clinics. Tailored trainings and resources were perceived as helpful for improving HIV testing, and PrEP provision in family planning settings and sustainable access to them via a centralized agency may be necessary to overcome ongoing capacity-related barriers. Additional strategies are necessary to ensure clinics are aware of and feel comfortable accessing the implementation strategies over time.