Table 3.

Strategies to Increase PrEP Use in FQHCs

i-PARIHS Component	Them^pe	Implementation Barrier/Determinant ( ±)	ERIC Strategy	Specific Strategy Elements	Mechanism of Strategies
Strategies Related to PrEP Information Dissemination
Recipients: Knowledge, Education, Motivations, Values, & Beliefs	PrEP Education Outreach Recommendations	PrEP uninformed /concerned about the side effects of PrEP (-)	Conduct educational meetings Distribute educational materials	❖ PrEP education at schools/colleges ❖ Health fairs, seminars, and interactive outreach webinars ❖ Flyers and pamphlets ❖ HIV testing events ❖ Utilize trusted sources (i.e., pastors and churches) ❖ Social media pages and radio stations ❖ Offer PrEP education during culturally relevant events	Conduct educational meetings in the community about HIV risk and PrEP side effects to increase awareness of the need for PrEP Collaborate with trusted members of the community to disseminate PrEP education to increase PrEP acceptance Distribute PrEP educational materials on social media platforms and radio stations to increase overall awareness of PrEP
Supportive Quotes	⇒ “There are so many people who could benefit from it [PrEP] and don't know about it. Education and awareness is key.”—Staff, Community Health Worker, Female ⇒ “They [FQHCs] have to utilize all resources to get their name out. We know social media is at an all-time high. Everybody uses it. Have someone post let’em know [PrEP is available].” -Patient, Age 50, Male, Taking PrEP ⇒ “Just a general health fair with havin’ somethin’ about the PrEP services there because, I’m gonna be honest with ya. If it was just a HIV health fair, I probably wouldn’t go.”—Patient, Age Unknown, Gender Unknown, Not on PrEP ⇒ “Try to talk about it [PrEP] more, schools, churches, everywhere.” -Patient, Age Unknown, Female, Taking PrEP ⇒ “Taking groups in the school. If you start early, it helps prevent, as they’re gettin’ older.”—Staff, Accountant, Female
Recipients: Knowledge, Education Context: Culture Innovation: Degree of novelty, Patient experience	Normalize PrEP	Unaware PrEP is for anyone at risk for HIV (-)	Develop educational materials Involve patients/consumers and family members	❖ Create diverse/inclusive advertisements for PrEP ❖ Provide education at a variety of places ❖ Share patient PrEP testimonials ❖ Screen all patients for PrEP ❖ Include PrEP when discussing other prevention concepts	Develop PrEP educational materials that include a variety of ages, races, and gender identities to enhance awareness that anyone at risk for HIV could benefit from PrEP Recruit and train community members who have taken PrEP to share their PrEP testimonials and PrEP education to increase PrEP knowledge and acceptance in the community
Supportive Quotes	⇒ “I think that they could possibly find a way for people that are taking PrEP to share their stories about PrEP. That’ll make people feel more comfortable with taking it. If I know some people that’s takin’ it [PrEP], and they feel really secure with it and comfortable, that may encourage me to try PrEP.” -Patient, Age 30, Female, Not on PrEP ⇒ “I feel like PrEP is for everybody regardless of who you’re sleepin’ with. I can be a churchgoin’ woman and love my husband. Anything can happen. We takin’ PrEP because everybody sleep with everybody. Just protect yourself.” -Patient, Age 23, Female, Not on PrEP
Increase Variety and Number of PrEP Providers
Context: Culture Innovation: Degree of novelty, Patient experience	Increase Provider PrEP Knowledge	Providers are not PrEP informed or don’t offer PrEP (-)	Use train-the-trainer strategies Conduct educational meetings	❖ Enhance provider PrEP knowledge ❖ Inform providers about PrEP payment assistant programs	Train designated PrEP providers to help provide PrEP education to other medical providers to increase the number of providers offering PrEP in MS Share PrEP payment assistance information with providers to increase awareness of resources
Supportive Quotes	⇒ “At first, it was very difficult to get providers to buy into the HIV program because new programs have to prove themselves to providers. It’s because they see so many programs come and go, and so they’re always reluctant to be like, We’re gonna add this program into our routine care and practices. Is it permanent? Is this another pop-up program?”– Staff, Clinical Quality Director, Female ⇒ “There's payment assistance, like coupons that they can add once your insurance goes through or if you don't have insurance, that covers it all, but a lot of people don't know about it.”—Patient, Age Unknown, Female, Not on PrEP
Context: Culture, Inter-organizational relationships Innovation: Clinical and patient experience, Degree of fit with existing practices	Increase Variety of PrEP Providers	Options for who to see to get PrEP will increase PrEP use ( +)	Conduct educational meetings Use train-the-trainer strategies	❖ Expand PrEP delivery to other specialties and types of providers ❖ Provide option to a PrEP provider not associated with their community ❖ Increase access to providers and navigators for patients to ask questions	Conduct educational meetings with clinic staff and clinicians to increase clinic staff and providers’ knowledge of PrEP Identify leaders to train providers’ in how to prescribe PrEP and increase their overall confidence prescribing PrEP. This will increase the overall number of PrEP prescriptions offered Identify specific opportunities for patients to ask questions related to PrEP
Supportive Quotes	⇒ “You have a certain doctor with PrEP that you go to for all your medications, and that's a main benefit, the privacy of it.”—Patient, Age 32, Female, Not on PrEP ⇒ “Heterosexual health care providers feel like they have the right to kinda lecture you on your sexual behavior from a point of privilege. “You know you’re gay, so should be—” And it is so offensive. I would rather them be gay so they can totally understand or a very culturally competent straight man.” -Patient, Age 28, Male, Taking PrEP
Enhance PrEP Provider Alliance and Trust
Recipients: Motivations, Values, & Beliefs Innovation: Clinical and patient experience	Enhance Patient/Provider alliance/communication	Judgement free providers increase PrEP use ( +)	Conduct educational meetings Distribute educational materials	❖ Enhance patient-provider alliance ❖ Culturally competent providers ❖ Judgement free environment ❖ Help patients weigh pros and cons ❖ Use published, scientific literature on PrEP to start the conversation ❖ Inform patients of the options for PrEP, (Truvada, Descovy, and Apretude)	Provide training to providers about cultural considerations and the different forms of PrEP (pill, injectable) and encourage providers to offer the different options tailored to patient needs to increase willingness to use PrEP Provide providers with literature on the efficacy of PrEP and the common side effects to utilize when discussing PrEP with patients in MS to increase patient understanding and willingness to use PrEP
Supportive Quotes	⇒ “I do [get people on PrEP], because I am transparent. And that I'm relatable. I try to always be honest with the people. I just try to tell, ‘you can't worry about what others say, but we have to do what we have to do for ourselves.’”—Staff, Nurse Director, Female ⇒ “He explained how these were common side effects of all medicine, that the studies of bone density, they had not been proved. There was no significant difference in the bone density of people who had been on PrEP for over an extended period of time versus those who had not. This made me, way more comfortable.” -Patient, Age 28, Male, Taking PrEP ⇒ “They listen to my questions instead of jumping in the middle, which a lotta doctors do.” -Patient, Age 23, Female, Not on PrEP
Innovation: Clinical and patient experience	Discreet Care	Concern about privacy when receiving PrEP (-)	Change service sites Develop resource sharing agreements	❖ Same reception and waiting area for all patients ❖ Provide discrete pill holders ❖ Offer secure ways to receive test results ❖ Offer on-site pharmacy or streamline pharmacy pickup	Increase the number of and variety service sites offering PrEP to help enhance confidentiality and increase comfort Collaborate with pharmacies eliminate pharmacy pickup as a barrier to PrEP uptake and persistence
Supportive Quotes	⇒ “We try our best to make it as private as possible. For our program, you don’t know if they’re going to just see the doctor for a regular annual checkup or a physical visit or for that program’cause it’s in one big clinic. That’s one good way that we kinda take away from the stigma.”– Staff, Accountant, Female ⇒ “I think telemedicine, they would probably prefer that. A private area would be the next option. But I think telemedicine for those that are uncomfortable, of someone seeing them.”—Staff, Director of Nurses, Female
Increase Access to PrEP
Recipients: Time & resources Context: Policy drivers, Inter-organizational relationships Recipients: Time & resources	Increase Access to PrEP	Limited access to PrEP appointments (-)	Change service sites Develop resource sharing agreements	❖ Mobile health units ❖ Home health/traveling PrEP nurse ❖ Same-day PrEP appointments ❖ Utilizing health clinics and community-based organizations ❖ Offer telemedicine appointments	Increase the number of sites delivering PrEP prescriptions to enhance access to PrEP among individuals in MS and increase PrEP use Develop partnerships with clinics and community health organizations to provide PrEP education and appointments to increase access to PrEP care Offer appointments via telemedicine to enhance adherence to PrEP appointments
Supportive Quotes	⇒ “It [same day PrEP appointments] would decrease the turnover rate because if you say, ‘Hey, we’re gonna get you an appointment today,’ that means you can do it today because, tomorrow, the individual may not be available, or they forgettin’ it, or change their mind.” -Patient, Age 50, Male, Taking PrEP ⇒ “If they could do like home health or travel PrEP people, that they could come out, like they have travel nurses that do some elderly patients, or patients who aren’t local.” -Patient, Age 28, Male, Taking PrEP ⇒ “I think if you offer a way for them to do the telemedicine, and offer ways for them to do their labs at home, we have better compliance.”- Staff, Clinical Quality Director, Female