Patient and Provider Perspectives on a Novel, Low-Threshold HIV PrEP Program for People Who Inject Drugs Experiencing Homelessness.

Autor: Bazzi AR; Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA. abazzi@health.ucsd.edu.; Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA. abazzi@health.ucsd.edu., Shaw LC; Boston Healthcare for the Homeless Program, Boston, MA, USA., Biello KB; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.; Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA.; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.; The Fenway Institute, Fenway Health, Boston, MA, USA., Vahey S; Boston Healthcare for the Homeless Program, Boston, MA, USA., Brody JK; Boston Healthcare for the Homeless Program, Boston, MA, USA.; Harvard Medical School, Boston, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2023 Mar; Vol. 38 (4), pp. 913-921. Date of Electronic Publication: 2022 May 25.
DOI: 10.1007/s11606-022-07672-5
Abstrakt: Background: HIV outbreaks among people who inject drugs (PWID) and experience homelessness are increasing across the USA. Despite high levels of need, multilevel barriers to accessing antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention persist for this population. The Boston Health Care for the Homeless Program (BHCHP) initiated a low-threshold, outreach-based program to support engagement in PrEP services among PWID experiencing homelessness.
Methods: To inform dissemination efforts, we explored patient and provider perspectives on key program components. From March to December 2020, we conducted semi-structured qualitative interviews with current and former BHCHP PrEP program participants and prescribers, patient navigators, and outreach workers (i.e., providers). Thematic analysis explored perspectives on key program components.
Results: Participants (n = 21) and providers (n = 11) identified the following five key components of BHCHP's PrEP program that they perceived to be particularly helpful for supporting patient engagement in PrEP services: (1) community-driven PrEP education; (2) low-threshold, accessible programming including same-day PrEP prescribing; (3) tailored prescribing supports (e.g., on-site pharmacy, short-term prescriptions, medication storage); (4) intensive outreach and navigation; and (5) trusting, respectful patient-provider relationships.
Discussion: Findings suggest that more patient-centered services formed the basis of BHCHP's innovative, successful PrEP program. While contextual challenges including competing public health emergencies and homeless encampment "sweeps" necessitate ongoing programmatic adaptations, lessons from BHCHP's PrEP program can inform PrEP delivery in a range of community-based settings serving this population, including syringe service programs and shelters.
(© 2022. The Author(s).)
Databáze: MEDLINE
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