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J Acquir Immune Defic Syndr. 2020 Jan 13. doi: 10.1097/QAI.0000000000002289. [Epub ahead of print]

PrEP implementation behaviors of community-based HIV testing staff: A mixed methods approach using latent class analysis.

Author information

1
College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., Tampa FL 33612.
2
Yale AIDS Prevention Training Program (Y-APT), Center for Interdisciplinary Research on AIDS (CIRA), Yale University, 135 College St. Suite 200, New Haven CT 06510.
3
Centre for Addiction and Mental Health (CAMH), 1001 Queen St W, West Wing 190, Toronto, ON M6J 1H4.
4
Midway Specialty Care Center, a 501 (c)3 organization, 2608 NE 16th Avenue, Wilton Manors, FL 33334.

Abstract

BACKGROUND:

Pre-exposure Prophylaxis (PrEP) is an important option for HIV prevention, but the approach has reached a limited number of people at risk for HIV infection.

METHODS:

A mixed methods concurrent triangulation design was employed to investigate unobserved subgroups of staff who provide community-based, publicly funded HIV testing in Florida (USA). PrEP implementation groups, or classes, were determined using Latent Class Analysis (LCA). Generalized linear mixed models were used to estimate PrEP implementation as a function of staff characteristics. In-depth interviews based on the Consolidated Framework for Implementation Research were analyzed thematically.

RESULTS:

Based on fit statistics and theoretical relevance, a 3-class LCA was selected. Class one ("Universal") staff were highly likely to talk about PrEP with their clients, regardless of client eligibility. Class two ("Eligibility dependent") staff were most likely to discuss PrEP if they believed their client was eligible. Class three ("Limited") staff sometimes spoke to clients about PrEP, but not systematically. In multivariate analyses, only race and sexual orientation remained significant predictors of PrEP implementation group. Staff who identified as a racial or sexual minority were less likely to be in the Limited group than their heterosexual or White counterparts. Age, gender, ever having taken PrEP, and HIV status did not impact the odds of being in a specific PrEP implementation group.

CONCLUSIONS:

A subset of HIV testing staff differentially discuss PrEP based on perceived client eligibility; others inconsistently talk to clients about PrEP. Targeted training based on PrEP implementation groups may be beneficial.

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