Yale University

Implementing PrEP in a Family Planning Setting

Principle Investigator(s):

Funder: National Institute of Mental Health
Project period: 06/14/2016 - 06/13/2017
Grant Type: Research

Abstract Text:

Pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) are effective biomedical prevention options that offer significant promise for women at risk for HIV; however, they are not routinely offered in healthcare settings and are consequently underutilized. Integrating biomedical HIV prevention within comprehensive reproductive health services may optimize delivery and improve uptake among women. The proposed study is a collaborative initiative between regional leaders of Planned Parenthood of Southern New England (PPSNE) and scientists at Yale’s Center for Interdisciplinary Research on AIDS (CIRA) to develop, deliver, and evaluate a program integrating biomedical HIV prevention into the reproductive health services currently offered at PPSNE centers in two small urban areas in Connecticut: Bridgeport and New Haven. As part of this project, we will test a novel PrEP introduction strategy, according to which all clients are emailed a link to a web video providing an informational overview of PrEP and nPEP, and compare this to a standard of care (clinician-delivered introduction during regular visit). An initial multi-level, mixed methods needs assessment will include key informant interviews with center managers of Planned Parenthood (PP) affiliates that have initiated PrEP in their centers (n = 2); interviews with PPSNE clinical care team members (n = 10) and leadership team members (n = 6), and an online survey of PPSNE clients (n = 150). This comprehensive assessment will illuminate PrEP/nPEP knowledge, attitudes, demand, training needs, implementation challenges, and service delivery preferences. Clientele, care team, and leadership perspectives will be used to inform the development of a clinical care team training tutorial, client education curriculum, web-based informational video, and protocols for the 2 implementation strategies (web introduction vs. standard introduction). Subsequent to clinical care team training and evaluation (n = 27), the protocols will be implemented at each of the two PPSNE centers (one per site). For eligible patients, PrEP will be provided on site and off-site referrals will be provided for nPEP. Program implementation strategies will be evaluated and compared in terms of feasibility, acceptability, and effectiveness through surveys with PPSNE clinical care and leadership teams (n = 16) and PPSNE clients (n = 225 total, 150 HIV-negative at-risk women) as well as objective indicators of PrEP interest and uptake. This study will result in improved understanding of women’s unique biomedical HIV prevention needs and preferences; a biomedical HIV prevention program tailored to women’s reproductive healthcare settings; evidence of the feasibility, acceptability, and preliminary effectiveness of various implementation strategies; and detailed protocols for implementation, including best practice recommendations.