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Reach

GENERAL QUESTION

  • What is the level of Reach?

  • WHO is (was) intended to benefit and who is actually participating in the PrEP program? 

  • Who is not participating and why?

  • What are the determinants of REACH? Barriers and facilitators 

EQUITY QUESTION

  • What are the characteristics of populations reach by PrEP?

  • To what extent is your project equitably reaching the intended participants that are socially and economically disadvantaged? 

Glasgow RE, Estabrooks PE. Pragmatic Applications of RE-AIM for Health Care... Prev Chronic Dis 2018;15:170271.

Sociodemographic Factors of Initiated Clients
Among the 141 clients who engaged with the clinic, 98 initiated PrEP: 

  • 98% Males

  • 68% Lived in KFL&A

  • 59% Had a primary care provider

  • Median age: 37 (29-51) years old

  • No client's injection drugs or are in heterosexual serodiscordant relationships)

STBBI History and Vaccination Among Initiated Clients
Among the 98 clients who initiated, they had the following history of STBBIs:

  • 27% Chlamydia

  • 18% Syphilis

  • 16% Gonorrhea

Among the 98 clients who initiated, vaccine rates were as follows:

  • 84% Hepatitis A

  • 84% Hepatitis B

  • 22% HPV​

Distribution of HIRI-MSM Items Among PrEP Clients who Initiated PrEP
ReachChart.png
Determinants of REACH- Barriers

Clients’ perspective

  • Contextual- stigma, lack of providers, geographical accessibility , medication cost

  • Organizational- limited schedules, limited outreach, poor advertisement

  • Individual barriers- lack of coverage, limited time availability

Who is the clinic NOT reaching?
(Narratives of clients)

  • Individuals not actively engaged in queer spaces or apps

  •  Individuals in rural areas, small towns

  •  University Students

Determinants of REACH

Clients’ perspective of those who WERE able to make it work, despite some of these initial barriers:

  • “the fact that is a little secluded is less chance of like feeling, feeling like people looking at you and stuff because like if you go into clinic, like, you know, why, why you're there, right? So it's it's I it is convenient in that regard. But yeah, in the middle of the winter was annoying like with snow and everything like because it's it's portsmouth, right? The sidewalks are not the best maintained. But yeah, that's a very small price to pay for all the benefit that it has.”

  • “once we were able to schedule the calls and everything, it was great.”

  • “Monday afternoons, right? It is, at least from my perspective, it is easy to accommodate. 
    OK, 'cause like I can just hop in a call. Very easy. When I had to go there, I had to plan for it, right? 
    So I had to pretty much block my afternoon, go there at least a couple hours. No, for me to right, especially with no car, then you have to more time for transportation. ”

Determinants of REACH- Barriers

Who is the clinic NOT reaching? (Narratives of Staff)

  • Transgender, women

  • People who use drugs, and 

  • Low income, uninsured individuals (immigrants, refugees, students)

Staff perspective

  • Contextual- stigma, lack of providers, geographical accessibility , medication cost, low SES

  • Intervention : eligibility tools

  • Organizational- limited support for social determinants, capacity constraints (staff), low recruitment strategies

  • Individual barriers- lack of coverage, low awareness and HIV literacy, stigma, self-perception of risk

Who is the clinic reaching?
(Narratives of clients and staff)

  • Previous users of STI Clinic

  • Highly aware of HIV prevention, advocacy skills

  • GBM, median age, knowledgeable of PrEP, and STIs

  • Population who can afford PrEP but also at high risk of HIV

  • Meeting needs of people recently in the province without health insurance

Determinants of REACH (facilitators)

Clients’ perspective

  • Organizational factors : Respectful and friendly staff, Value of specialized care, Safe space; Simplicity and support; Non-judgmental 

  • Intervention: Flexible care; Accessible information; Satisfaction with process; positive perception of effectiveness of PrEP; adaptability

  • Individual: social and personal responsibility, sexual pleasure, social influence, addressing stigma

Staff perspective

  • Organizational factors: culture (equity), networks with GBM

  • Outer setting: partnerships with communities

  • Intervention: Effective in GBM, relative priority

Recommendations

Client perspective

  • Increase outreach   

  • Changing scheduling

Staff perspective

  • Funding- free access to PrEP

  • Refined outreach

  • Flexible service delivery

  • Normalize conversations

  • Strategic goals

  • Navigational support

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