Table 1.

Pre-exposure prophylaxis optimization among women to enhance retention and uptake implementation strategies and corresponding levels, determinants, and mechanisms of change.

POWER Upa strategy		CFIRb level	Implementation barrier or facilitator	ERICc strategies	Mechanism of change
Routine patient education
	Develop a guide for delivering PrEPd education by discussions during appointments Develop brochures and pamphlets with specific considerations for Black cisgender women	Inner setting Characteristics of individuals	Patient knowledge deficit (-) Patient beliefs toward HIV vulnerability (-)	Develop educational materials Prepare patients to be active participants Intervene with patients to enhance uptake and adherence Conduct ongoing training	Awareness- building Knowledge-acquisition Self-efficacy
Provider training
	Develop training sessions for providers to complete that include providing patient education; identifying PrEP-eligible women; how to offer PrEP; how to work with PrEP navigation team; practicing difficult conversations with digital Black cisgender female patients (avatars and role play)	Intervention characteristics Inner setting Characteristics of individuals	Provider knowledge deficit (-) Competing clinical demands (-) Provider low comfort level in discussing PrEP (-)	Provide clinical supervision Audit and provide feedback Conduct ongoing training Make training dynamic	Awareness-building Knowledge-acquisition Self-efficacy
PrEPd navigation
	Determine staff who will be designated as PrEP navigators Develop model to delineate roles and responsibilities of PrEP navigators to meet with patients to support initiation and monthly check-ins to support persistence thereafter (appointments, refill reminders based on patients’ own schedule)	Inner setting Outer setting	Turnover of staff (-) Limited staff to support PrEP uptake (-) Clinic programs (+) Integrating services (+) Clinic visits (-) Laboratory results (-)	Tailor strategies Create new clinical teams	Capacity building Real-time training and consultation
EMRe optimization
	Assess existing EMRe software and templates for documenting HIV risk factors Implement clinical decision support tools for identification of PrEP candidates and prescription of PrEP Develop and incorporate PrEP indication documentation into the EMR Provide regular electronic reports of PrEP care continuum outcomes for clinic staff to review and act upon	Intervention characteristics Inner setting	Dosing (-) Prescription (-) EMR reminders (+)	Facilitate relay of clinical data to providers Remind clinicians Centralize technical assistance Use data experts	Capacity building Streamline processes Real-time training and consultation
Clinical champions
	Determine staff who will be designated as clinical champions through early adopters Communicate to clinic staff who the champions are and identify their role to support facilitation of PrEP uptake (clinical innovation)	Inner setting Characteristics of individuals	Clinic programs (+) Knowledge (-/+)	Facilitation Identify and prepare champions Identify early adopters Capture and share local knowledge Use an implementation advisor Use “train the trainer” strategies	Real-time training and consultation Support knowledge and skill gain of staff

^aPOWER Up: PrEP Optimization among Women to Enhance Retention and Uptake.

^bCFIR: Consolidated Framework for Implementation Research.

^cERIC: Expert Recommendations for Implementing Change.

^dPrEP: pre-exposure prophylaxis.

^eEMR: electronic medical record.