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Disparities in HIV Pre-Exposure Prophylaxis Implementation for Black and Latinx Adults Receiving Care in Public Health Clinics

Schexnayder, Julie Kay
http://orcid.org/0000-0002-3902-2683
http://rave.ohiolink.edu/etdc/view?acc_num=case160709474635545

Abstract Details

2021, Doctor of Philosophy, Case Western Reserve University, Nursing.
Pre-exposure prophylaxis (PrEP) effectively reduces the risk of Human Immunodeficiency Virus (HIV) infection. PrEP implementation in public health clinics is suggested for increasing PrEP access; However, it is unclear if these venues can reduce the disparities in PrEP use that are observed for Black and Latinx adults. We analyzed data from health departments completing their first PrEP program year between June 1, 2016 and June 30, 2019. We estimated PrEP coverage and adherence in Black and Latinx clients. Semi-structured interviews were conducted with multidisciplinary public health workers (n=6). The Consolidated Framework for Implementation guided a thematic analysis of interviews. Of the 433 PrEP clients, 52.0% were non-Hispanic Black and 8.9% were Hispanic/Latinx. PrEP to need ratios were greater for White clients than for Black or Latinx clients at five of the nine health departments. The average medication possession ratio for Black and Latinx PrEP clients (.79) approached effective daily adherence levels. However, a single prescription was filled for 25.0% of Black and Latinx clients. Qualitative data indicated compatibility issues between PrEP services delivery and community preferences and needs. Challenges integrating longitudinal follow-up practices, and complex PrEP re-enrollment procedures emerged as additional factors influencing PrEP outcomes. The results of this dissertation indicate that public health clinics vary in their ability to deliver all components of PrEP clinical monitoring and in their ability to increase PrEP coverage in Black and Latinx adults. Tailoring of PrEP services to Black and Latinx adults may be necessary to optimize PrEP coverage and adherence.
Allison Webel, PhD, RN (Committee Chair)
Mary Dolansky, PhD, RN (Committee Member)
Patricia Higgins, PhD, RN (Committee Member)
Darcy Freedman, PhD, MPH (Committee Member)
167 p.
Nursing; Public Health
HIV prevention, pre-exposure prophylaxis, PrEP, public health clinics

Recommended Citations

Citations

  • Schexnayder, J. K. (2021). Disparities in HIV Pre-Exposure Prophylaxis Implementation for Black and Latinx Adults Receiving Care in Public Health Clinics [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case160709474635545

    APA Style (7th edition)

  • Schexnayder, Julie. Disparities in HIV Pre-Exposure Prophylaxis Implementation for Black and Latinx Adults Receiving Care in Public Health Clinics. 2021. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case160709474635545.

    MLA Style (8th edition)

  • Schexnayder, Julie. "Disparities in HIV Pre-Exposure Prophylaxis Implementation for Black and Latinx Adults Receiving Care in Public Health Clinics." Doctoral dissertation, Case Western Reserve University, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case160709474635545

    Chicago Manual of Style (17th edition)

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© 2021, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.