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Recent studies have shown social determinants of health (SDOH) to impact HIV care engagement. This cross-sectional study (Oct 20-Apr 21) assessed the impact of a range of SDOH on HIV care engagement using data from HIV Care Connect, a consortium of three HIV care facility-led programs (Alabama, Florida, Mississippi). The exposures were captured using the PRAPARE (Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences) scale. The outcome was captured using the Index of Engagement in HIV Care scale. Participants (n = 132) were predominantly non-White (87%) and male (52%) with a median age of 41 years. Multivariable logistic regression adjusted for various sociodemographics showed lower HIV care engagement to be associated with being uninsured/publicly insured, having 1-3 unmet needs, socially integrating ≤five times/week, and having stable housing. Factors such as unmet needs, un-/underinsurance, and social integration may be addressed by healthcare and community organizations. Plain Language Summary: Assessing How Social Drivers of Health Affect Engagement in HIV Care in the Southern United States It has been found that social factors that have a direct impact on health affect engagement in HIV Care among people living with HIV. We included various social drivers of health to see how they affect engagement in HIV Care. We used data between October 2020 and April 2021 from a project titled HIV Care Connect, which is a group of three facilities providing HIV care in Alabama, Florida, and Mississippi. We used social drivers of health as risk factors from a scale called PRAPARE (Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences). Engagement in HIV care was measured by using a scale called Index of Engagement in HIV Care. A total of 132 participants were included. Majority of the participants were of races other than white (87%), male (52%) and were aged 41 years on average. Statistical analysis showed that participants without insurance or with public insurance, participants with 1-3 unsatisfied needs, participants that met with other people less than or equal to five times a week, and participants that had reliable housing had lower engagement in HIV care. These factors have a potential to be addressed by healthcare and community organizations. [ABSTRACT FROM AUTHOR]

Background: HIV disproportionately affects Black women in the Southern U.S., yet utilization of HIV pre-exposure prophylaxis (PrEP) for HIV prevention among cis-gender women remains low, with particularly inequitable access among Black women. Gynecology clinics provide an ideal location for PrEP services, alongside already-available sexual, reproductive, and primary health care services for many cis-gender women. Methods: We conducted qualitative in-depth interviews with key informants at a gynecology continuity clinic serving under- and uninsured women in Alabama to evaluate individual-, setting-, and process-level determinants of PrEP care provision. The clinic serves approximately 3,000 women yearly, 64% of whom are Black women. Interview guides utilized the Information-Motivation- Behavioral Skills Model to explore barriers and facilitators affecting PrEP implementation, including provider knowledge about PrEP, motivations to integrate PrEP into routine gynecologic care, and skills needed to deliver PrEP care. A codebook was developed from interview transcripts, and further detailed inductive codes were developed by the study team. Interviews were coded by two team members to identify emergent themes. Results: Seven key informants participated in interviews, with a mean age of 33 years and positions including, among others, attending and trainee physicians. The following themes emerged: (1) Gynecology providers discuss sexual health with their patients, but rarely discuss PrEP; (2) Providers support an interdisciplinary team approach to PrEP implementation, inclusive of physicians, advanced practice providers, nurses, medical assistants, and office staff; (3) Longitudinal and iterative provider education on PrEP is an important motivator for discussions about PrEP with patients; (4) Providers need communication and cultural competency skills to build trust and rapport with patients, which ameliorate community stigma around discussions about HIV prevention. Conclusion: PrEP implementation in gynecology clinics can improve access to HIV prevention for cisgender Black women in Alabama. Increasing provider knowledge about PrEP provision and care boosts provider confidence discussing PrEP with patients. Utilizing an interdisciplinary approach across clinic staff may normalize PrEP discussions, allowing patients time to ask questions at many intervals with providers trained on providing culturally appropriate care. These findings will inform development of implementation strategies to integrate PrEP care into routine gynecologic care in the American South. [ABSTRACT FROM AUTHOR]

Introduction: Ending the HIV Epidemic initiatives provide a unique opportunity to use implementation scientific methods to guide implementation of evidence-based practices and evaluate their effectiveness in real-word settings to improve HIV inequities. This report demonstrates our use of Implementation Mapping (IM) to engage participating county health departments, AIDS services organizations, and community-based organizations in the development of a data dashboard to track the PrEP care continuum for the state of Alabama, an Ending the HIV Epidemic hotspot., Methods: Our project is guided by an overarching Implementation Research Logic Model and by the tenets of IM, a 5-step approach to support researchers and community partners in the systematic selection, development, and/or tailoring of implementation strategies to increase program adoption, implementation, and sustainability., Results: Step 1, the needs assessment, established baseline data elements for a PrEP care continuum for participating community-based organizations, AIDS services organizations, and the state health department as well as investigated their desire for data visualization and willingness to share data to inform initiatives to improve PrEP access. Step 2 identified adaptability, relative advantage, and complexity as determinants of intervention adoption. Based on findings from steps 1 and 2, the investigators and community partners determined to move forward with development of a data dashboard. Step 3 identified the following implementation strategies to support a dashboard, including development of educational materials, synchronous and asynchronous training, technical assistance, and improved record systems., Discussion: Using IM supports community-engaged researchers in designing strategies to end the epidemic that are context-specific and more impactful in real-word settings., Competing Interests: L.E. is currently receiving a grant (MK8591-022) from Merck, has consulted for Black AIDS Institute, and is a speaker for MedIQ who provide CME. The remaining authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)