This one-year supplement proposal was developed by University of Miami Schools of Medicine and Psychology, and Latinos Salud?a HRSA-funded case management, testing and prevention agency with a clinic that provides Pre-Exposure Prophylaxis (PrEP) services. The goal of this implementation science project is to understand modifiable factors and the behavior of practitioners and support staff, clients, and stakeholders influencing the adoption and implementation of DiversiPrEP, a culturally tailored PrEP program for Latinos. DiversiPrEP uses a client-centered service model (both in person and with telehealth) to advance routine HIV testing and deliver PrEP. DiversiPrEP helps Latinos learn about PrEP, decide if PrEP is relevant for their lives, navigate health insurance or patient assistance programs, access PrEP, and sustain PrEP use. DiversiPrEP is offered at all four of Latinos Salud?s sites located in Broward and Miami-Dade counties?collectively the counties with the highest HIV incidence and prevalence in the US. To enable cross-site collaboration, we selected five strategies from the Expert Recommendations for Implementing Change (ERIC) project. These strategies were systematically compiled by stakeholders to ensure standardization (Increase Demand, Promote Adaptability, Alter Client Fees, Intervene with Clients to Enhance Uptake and Adherence, and Tailor Strategies).
Our Aims are guided by implementation science frameworks to identify testable mechanisms influencing implementation success, contribute to expanding PrEP services provided by HRSA-funded clinics, and advance implementation science.
Aim 1. Mixed methods interviews with staff will identify Consolidated Framework for Implementation Science Research (CFIR) modifiable factors that explain the implementation of DiversiPrEP in the four geographic areas where Latinos Salud sites are located. Each area is characterized by the presence of a large sub-population: Miami Beach (tourists), Southwest Miami (university students), Homestead (seasonal farmworkers) and Broward (middle aged men who have sex with men-MSM). We will also identify CFIR modifiable factors by clientele group (Latino MSM, non-Latino MSM, cisgender female and transgender people) using photovoice. Photovoice is a technique that uses photos and narratives, and provides a safe space for participants to share stories, fears, concerns, and hopes for accessing and using PrEP.
Aim 2. We will refine ERIC implementation strategies through an Evidence Based Quality Improvement (EBQI) process with clinicians, administrators, front line staff, stakeholders and implementation science experts.
Aim 3. We will evaluate DiversiPrEP?s Reach (the extent to which PrEP is delivered to at-risk persons) and Implementation (the extent to which DiversiPrEP is delivered as designed) using RE-AIM. Deliverables: 1) a logic model to structure and prioritize specific implementation constructs. 2) An operational manual and peer reviewed publications to summarize lessons learned and formulate a process for developing DiversiPrEP?s implementation strategies to support PrEP delivery at scale and in other HRSA-funded clinics serving Latinos.
The proposed project is significant for its potential to guide the large-scale implementation of a client-centered PrEP service model with telehealth through HRSA-funded clinics serving Latino populations. Significance is enhanced by inclusion of stakeholders and a rigorous assessment of implementation science processes that increase the efficiency of research and the generalizability and interpretability of our research findings, which will in turn contribute to advancing implementation science.
