Level of adoption of PrEP in sexual health Clinics
2 prescribed PrEP on site
6 Referred patients with established path
2 Referred patients without established path
2 no familiar
with PrEP enough to offer or referred appropriately
Characteristics of the intervention
PrEP is widely acknowledged as an effective, evidence-based intervention, with its source and strength of evidence posing no barriers to adoption.
Its relative advantage as a strategy to reduce new HIV infections is recognized, although some settings note that the low HIV incidence—coupled with higher rates of syphilis and gonorrhea—could shift priorities.
Adaptability is a facilitator, as existing practices allow for alternative approaches such as referrals, use of the web, and local pharmacy involvement; however, these practices may need to be further tailored for populations like people who inject drugs, the homeless, and indigenous communities.
Complexity is managed through clear guidelines and medical directives, which aid in the adoption process, but the multiple steps involved still present challenges that can be mitigated through additional training and the use of medical directives.
The overall design of the intervention is positive, bolstered by favorable attitudes towards PrEP and supportive directives.
Cost remains the primary barrier, with uncertainties about the full expenses of implementation and how costs for clients will be managed. In response, strategies such as conducting cost-effectiveness analyses, seeking new funding sources, and better navigating current funding mechanisms have been recommended.
Outer Settings
One critical theme is the impact of COVID-19: while some settings have successfully adapted their services through innovative methods like mobile clinics and outreach, the pandemic has also led to staff reductions, shifts to online work, and the elimination of some programs, complicating service delivery.
Local attitudes generally PrEP is positively perceived among at-risk populations; however, primary care providers often exhibit a lack of interest and limited capacity, compounded by ongoing HIV and PrEP-related stigma. Rising HIV and syphilis rates, along with a perceived need for PrEP to mitigate HIV incidence, underscore its importance, yet social challenges—particularly among homeless individuals, people who inject drugs, and aboriginal communities—create barriers to access. Rural areas and small cities, where access to PrEP resources is limited and many residents lack primary care providers, further exacerbate these challenges, suggesting a need for targeted reach-out programs and mobile service provision.
Policies and guidelines are seen as a strong foundation, as public health standards facilitate the management of sexually transmitted infections, yet weak provincial support and minimal external mandates hinder broader adoption.
Networking and partnerships, including collaborations with community-based organizations, research projects, and inter-agency learning networks, have enabled more effective referral pathways and resource sharing, although some organizations still struggle with establishing robust connections.
Financing remains a significant concern: program cuts due to COVID-19, unclear funding sources for PrEP, and limited free access underscore the urgency for clear financial strategies, including PrEP navigation funding and upstream commitments to support program sustainability.
Inner Settings
Structural characteristics are favorable, as clinics with a clear trajectory and internal organization—especially those serving priority populations—are well positioned to implement PrEP, with no notable barriers in this area.
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The organizational culture is a strong facilitator, characterized by values of respect, dedication to comprehensive care, and a commitment to evaluating and adapting programs, with no barriers identified. In terms of tension for change, positive experiences—such as successful adaptations during COVID-19 and a clear need to reduce HIV incidence—support PrEP adoption, although some clinics cite capacity constraints and shifting priorities as challenges that could be addressed through targeted training.
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Regarding compatibility, PrEP is generally seen as fitting well with current public health mandates, but there is some concern about its placement within primary care settings; recommended strategies include increasing personnel capacity, hiring new staff, and leveraging telehealth options.
A positive learning climate exists, marked by openness to innovation, willingness for tailored training, and prior research experience, though some settings still require more localized training efforts.
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The availability of resources is generally favorable due to interdisciplinary teams and existing expertise in HIV and STI testing and counseling, yet some clinics need additional prescribers, lab support, and time.
Process
One critical theme is the impact of COVID-19: while some settings have successfully adapted their services through innovative methods like mobile clinics and outreach, the pandemic has also led to staff reductions, shifts to online work, and the elimination of some programs, complicating service delivery.
Local attitudes generally PrEP is positively perceived among at-risk populations; however, primary care providers often exhibit a lack of interest and limited capacity, compounded by ongoing HIV and PrEP-related stigma. Rising HIV and syphilis rates, along with a perceived need for PrEP to mitigate HIV incidence, underscore its importance, yet social challenges—particularly among homeless individuals, people who inject drugs, and aboriginal communities—create barriers to access. Rural areas and small cities, where access to PrEP resources is limited and many residents lack primary care providers, further exacerbate these challenges, suggesting a need for targeted reach-out programs and mobile service provision.
Policies and guidelines are seen as a strong foundation, as public health standards facilitate the management of sexually transmitted infections, yet weak provincial support and minimal external mandates hinder broader adoption.
Networking and partnerships, including collaborations with community-based organizations, research projects, and inter-agency learning networks, have enabled more effective referral pathways and resource sharing, although some organizations still struggle with establishing robust connections.
Financing remains a significant concern: program cuts due to COVID-19, unclear funding sources for PrEP, and limited free access underscore the urgency for clear financial strategies, including PrEP navigation funding and upstream commitments to support program sustainability.