Applying Implementation Science Frameworks to Identify Factors That Influence the Intention of Healthcare Providers to Offer PrEP Care and Advocate for PrEP in HIV Clinics in Colombia: a Cross-sectional Study

Overview

Journal Implement Sci Commun

Publisher Biomed Central

Specialty Health Services

Date 2022 Mar 17

PMID 35296369

Authors

Jorge Luis Martinez-Cajas

Julian Torres

Hector Fabio Mueses

Pilar Camargo Plazas

Marcela Arrivillaga

Sheila Andrea Gomez

Ximena Galindo

Ernesto Martinez Buitrago

Beatriz Eugenia Alvarado Llano

Affiliations

Soon will be listed here.

Abstract

Background: Few studies have used implementation science frameworks to identify determinants of PrEP prescription by healthcare providers. In this work, we developed and psychometrically examined a questionnaire using the theoretical domains framework (TDF) and the consolidated framework for implementation research (CFIR). We used this questionnaire to investigate what factors influence the intention of healthcare providers to offer PrEP care and advocate for PrEP.

Methods: We conducted a cross-sectional study in 16 HIV healthcare organizations in Colombia. A 98-item questionnaire was administered online to 129 healthcare professionals. One hundred had complete data for this analysis. We used exploratory factor analysis to assess the psychometric properties of both frameworks, and multinomial regression analysis to evaluate the associations of the frameworks' domains with two outcomes: (1) intention to offer PrEP care and (2) intention to advocate for PrEP impmentation.

Results: We found support for nine indices with good internal consistency, reflecting PrEP characteristics, attitudes towards population needs, concerns about the use of PrEP, concerns about the role of the healthcare systems, knowledge, beliefs about capabilities, professional role, social influence, and beliefs about consequences. Notably, only 57% of the participants were likely to have a plan to care for people in PrEP and 66.7% were likely to advocate for PrEP. The perception of the need for PrEP in populations, the value of PrEP as a practice, the influence of colleagues, and seeing PrEP care as a priority was related to being less likely to be unwilling to provide or advocate for PrEP care.

Conclusion: Our findings suggested the importance of multilevel strategies to increase the provision of PrEP care by healthcare providers including adquisition of new skills, training of PrEP champions, and strength the capacity of the health system.

Citing Articles

Determinants of Familiarity and Experience with HIV Pre-Exposure Prophylaxis in Primary Care Providers in Ontario, Canada.

Martinez-Cajas J, Alvarado B, Rapino C, Nagy E, Guan T, Cofie N J Prim Care Community Health. 2025; 16():21501319251315566.

PMID: 39846350 PMC: 11755537. DOI: 10.1177/21501319251315566.

Pre-exposure prophylaxis (PrEP) among people who use drugs: a qualitative scoping review of implementation determinants and change methods.

Merle J, Zapata J, Quieroz A, Zamantakis A, Sanuade O, Mustanski B Addict Sci Clin Pract. 2024; 19(1):46.

PMID: 38816889 PMC: 11138081. DOI: 10.1186/s13722-024-00478-2.

References

Hakre S, Blaylock J, Dawson P, Beckett C, Garges E, Michael N . Knowledge, attitudes, and beliefs about HIV pre-exposure prophylaxis among US Air Force Health Care Providers. Medicine (Baltimore). 2016; 95(32):e4511. PMC: 4985324. DOI: 10.1097/MD.0000000000004511. View

Bil J, Hoornenborg E, Prins M, Hogewoning A, Dias Goncalves Lima F, de Vries H . The Acceptability of Pre-Exposure Prophylaxis: Beliefs of Health-Care Professionals Working in Sexually Transmitted Infections Clinics and HIV Treatment Centers. Front Public Health. 2018; 6:5. PMC: 5811525. DOI: 10.3389/fpubh.2018.00005. View

Cerqueira N, Vasconcelos R, Hojilla J, Kallas E, Avelino-Silva V . Attitudes and Knowledge About Human Immunodeficiency Virus Pre-Exposure Prophylaxis Among Brazilian Infectious Disease Physicians. AIDS Res Hum Retroviruses. 2020; 36(12):1047-1053. DOI: 10.1089/AID.2019.0281. View

Saberi P, Berrean B, Thomas S, Gandhi M, Scott H . A Simple Pre-Exposure Prophylaxis (PrEP) Optimization Intervention for Health Care Providers Prescribing PrEP: Pilot Study. JMIR Form Res. 2019; 2(1). PMC: 6325636. DOI: 10.2196/formative.8623. View

Keith R, Crosson J, OMalley A, Cromp D, Taylor E . Using the Consolidated Framework for Implementation Research (CFIR) to produce actionable findings: a rapid-cycle evaluation approach to improving implementation. Implement Sci. 2017; 12(1):15. PMC: 5303301. DOI: 10.1186/s13012-017-0550-7. View

Pinto R, Kay E, Wall M, Choi C . Interprofessional Collaboration Improves the Odds of Educating Patients About PrEP over Time. J Gen Intern Med. 2020; 35(5):1444-1451. PMC: 7210328. DOI: 10.1007/s11606-019-05616-0. View

Prochaska J, Redding C, Harlow L, Rossi J, Velicer W . The transtheoretical model of change and HIV prevention: a review. Health Educ Q. 1994; 21(4):471-86. DOI: 10.1177/109019819402100410. View

Frasca K, Castillo-Mancilla J, McNulty M, Connors S, Sweitzer E, Zimmer S . A Mixed Methods Evaluation of an Inclusive Sexual History Taking and HIV Prevention Curriculum for Trainees. J Gen Intern Med. 2019; 34(7):1279-1288. PMC: 6614307. DOI: 10.1007/s11606-019-04958-z. View

Aguayo-Romero R, Reisen C, Zea M, Bianchi F, Poppen P . Gender Affirmation and Body Modification Among Transgender Persons in Bogotá, Colombia. Int J Transgend. 2016; 16(2):103-115. PMC: 4733647. DOI: 10.1080/15532739.2015.1075930. View

10.

Desai M, Gafos M, Dolling D, McCormack S, Nardone A . Healthcare providers' knowledge of, attitudes to and practice of pre-exposure prophylaxis for HIV infection. HIV Med. 2015; 17(2):133-42. DOI: 10.1111/hiv.12285. View

11.

Sharma M, Wilton J, Senn H, Fowler S, Tan D . Preparing for PrEP: perceptions and readiness of canadian physicians for the implementation of HIV pre-exposure prophylaxis. PLoS One. 2014; 9(8):e105283. PMC: 4136811. DOI: 10.1371/journal.pone.0105283. View

12.

Blumenthal J, Jain S, Krakower D, Sun X, Young J, Mayer K . Knowledge is Power! Increased Provider Knowledge Scores Regarding Pre-exposure Prophylaxis (PrEP) are Associated with Higher Rates of PrEP Prescription and Future Intent to Prescribe PrEP. AIDS Behav. 2015; 19(5):802-10. PMC: 4417031. DOI: 10.1007/s10461-015-0996-z. View

13.

Fernandez M, Ruiter R, Markham C, Kok G . Intervention Mapping: Theory- and Evidence-Based Health Promotion Program Planning: Perspective and Examples. Front Public Health. 2019; 7:209. PMC: 6702459. DOI: 10.3389/fpubh.2019.00209. View

14.

Pinto R, Berringer K, Melendez R, Mmeje O . Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature. AIDS Behav. 2018; 22(11):3681-3691. PMC: 6208917. DOI: 10.1007/s10461-018-2184-4. View

15.

Sheth A, Hussen S, Escoffery C, Haddad L, Powell L, Brown N . Pre-Exposure Prophylaxis Integration Into Family Planning Services at Title X Clinics in the Southeastern United States: Protocol for a Mixed Methods Hybrid Type I Effectiveness Implementation Study (Phase 2 ATN 155). JMIR Res Protoc. 2020; 9(9):e18784. PMC: 7547391. DOI: 10.2196/18784. View

16.

Bacon O, Gonzalez R, Andrew E, Potter M, Iniguez J, Cohen S . Brief Report: Informing Strategies to Build PrEP Capacity Among San Francisco Bay Area Clinicians. J Acquir Immune Defic Syndr. 2016; 74(2):175-179. PMC: 5233589. DOI: 10.1097/QAI.0000000000001182. View

17.

Piper K, Haardorfer R, Escoffery C, Sheth A, Sales J . Exploring the heterogeneity of factors that may influence implementation of PrEP in family planning clinics: a latent profile analysis. Implement Sci Commun. 2021; 2(1):48. PMC: 8097793. DOI: 10.1186/s43058-021-00148-3. View

18.

Pleuhs B, Quinn K, Walsh J, Petroll A, John S . Health Care Provider Barriers to HIV Pre-Exposure Prophylaxis in the United States: A Systematic Review. AIDS Patient Care STDS. 2020; 34(3):111-123. PMC: 7087402. DOI: 10.1089/apc.2019.0189. View

19.

Petroll A, Walsh J, Owczarzak J, McAuliffe T, Bogart L, Kelly J . PrEP Awareness, Familiarity, Comfort, and Prescribing Experience among US Primary Care Providers and HIV Specialists. AIDS Behav. 2016; 21(5):1256-1267. PMC: 5500978. DOI: 10.1007/s10461-016-1625-1. View

20.

Sharma M, Chris A, Chan A, Knox D, Wilton J, McEwen O . Decentralizing the delivery of HIV pre-exposure prophylaxis (PrEP) through family physicians and sexual health clinic nurses: a dissemination and implementation study protocol. BMC Health Serv Res. 2018; 18(1):513. PMC: 6029110. DOI: 10.1186/s12913-018-3324-2. View