Situational Analysis of PrEP

We selected the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to practice change and to design implementation strategies for PrEP adoption (organizational) and prescription (individual). The CFIR was chosen a priori to guide the evaluation by highlighting what works well and identifying opportunities for improvement throughout the implementation process. 

The framework comprises five main domains that may affect PrEP implementation.  

The first domain concerns the characteristics of the intervention, which includes primary care providers’ perceptions of PrEP sources, adaptability, and complexity, among other factors. The second domain, the outer setting, encompasses the economic, political, and social context in which an organization operates. In our case, it refers to the political and health systems that public health settings are part of, as well as how organizations address the needs, resources, and preferences of people disproportionally affected by HIV, alongside relevant guidelines and external pressures.

The inner setting domain focuses on the organizational characteristics of sexual health clinics, examining elements such as organizational structure, community connections, culture, and the overall implementation climate. The fourth domain addresses the characteristics of individuals involved in PrEP experience, including their knowledge and self-efficacy. 

Finally, the process domain covers the steps of implementation—planning, engaging stakeholders, executing the plan, and reflecting on and evaluating the efforts. In this study, we explored the various factors that have facilitated its successful adoption.