Implementation - fidelity
GENERAL QUESTION
-
What is the level of fidelity, implementing PrEP?
-
HOW was it be adapted?
-
HOW much will (did) it cost?
-
Acceptability and appropriateness of the services?
EQUITY QUESTION
-
Which adaptation may decrease inequities?
-
Could cost and adaptations increase inclusion?
Fidelity (clients’ narratives)
First appointment/phone
-
Initial evaluations tailored to individual needs, including sexual health and broader health history.
-
Conversation on beneficial effects on PrEP and how fit their needs
-
Thorough evaluation of the potential risks and benefits of PrEP, leading to a balanced decision-making process.
-
Comprehensive explanation of medication and side effects during initial appointments.
Anonymous client quotes
Potential side effects, cost, and ease of use were considerations clients had when deciding if PrEP was a good fit for them:
“I know there was some talk, I think kidney kind of function is, is a little bit of concern. So just kind of wanted to get a sense is it easy to start and stop? I think kind of the cost point of view as well was just kind of getting a sense kind of what that what that looks like as well.”
Monitoring
-
Participants mentioned that staff discussed PrEP alternatives.
-
Repeated interactions with providers were recognized by participants as valuable, fostering trust, reducing stigma, and supporting adherence to the program.
-
Challenges with Fidelity in terms of testing for STIs was noted by one participant.
Client narratives
“And then also liked having the like pre scheduled like 3 month kind of follow-ups where it's not on you to like, oh, don't forget to go and get your recs done. And that it was like, oh, I know I've got to get it done by this date because I've got an appointment at this time.”