State-level clustering in PrEP implementation factors among family planning clinics in the Southern United States

Frontiers in Public Health

Public Health

Jessica M. Sales¹  Matthew A. Psioda²  Micah McCumber²  Kimberly P. Enders²  Aditi Ramakrishnan³  Anandi N. Sheth³ 

[1] Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States;Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States;

关键词: Southern U.S.;    women;    PrEP;    family planning;    implementation;   

DOI  :  10.3389/fpubh.2023.1214411

 received in 2023-04-29, accepted in 2023-07-12,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundAvailability of PrEP-providing clinics is low in the Southern U.S., a region at the center of the U.S. HIV epidemic with significant HIV disparities among minoritized populations, but little is known about state-level differences in PrEP implementation in the region. We explored state-level clustering of organizational constructs relevant to PrEP implementation in family planning (FP) clinics in the Southern U.S.MethodsWe surveyed providers and administrators of FP clinics not providing PrEP in 18 Southern states (Feb-Jun 2018, N = 414 respondents from 224 clinics) on these constructs: readiness to implement PrEP, PrEP knowledge/attitudes, implementation climate, leadership engagement, and available resources. We analyzed each construct using linear mixed models. A principal component analysis identified six principal components, which were inputted into a K-means clustering analysis to examine state-level clustering.ResultsThree clusters (C1–3) were identified with five, three, and four states, respectively. Canonical variable 1 separated C1 and C2 from C3 and was primarily driven by PrEP readiness, HIV-specific implementation climate, PrEP-specific leadership engagement, PrEP attitudes, PrEP knowledge, and general resource availability. Canonical variable 2 distinguished C2 from C1 and was primarily driven by PrEP-specific resource availability, PrEP attitudes, and general implementation climate. All C3 states had expanded Medicaid, compared to 1 C1 state (none in C2).ConclusionConstructs relevant for PrEP implementation exhibited state-level clustering, suggesting that tailored strategies could be used by clustered states to improve PrEP provision in FP clinics. Medicaid expansion was a common feature of states within C3, which could explain the similarity of their implementation constructs. The role of Medicaid expansion and state-level policies on PrEP implementation warrants further exploration.

【 授权许可】

Unknown   
Copyright © 2023 Sheth, Enders, McCumber, Psioda, Ramakrishnan and Sales.