WHERE CAN SOUTHERN GIRLS GO FOR PREP? EXAMINING THE PREP-PROVIDING PRACTICES OF TITLE-X FUNDED FAMILY PLANNING CLINICS ACROSS THE SOUTHERN US

Purpose: Pre-exposure prophylaxis (PrEP) for HIV prevention is dramatically underutilized by women of all ages in the US, particularly among young women in the Southern US who are disproportionately affected by HlV. Improving PrEP access is a key component of increasing PrEP uptake among women. Title X-funded family planning clinics have been identified as potentially ideal PrEP delivery sites for women. Yet little is known about the extent to which PrEP is provided in these settings, nor about the barriers and facilitators to PrEP provision. We examined PrEP provision practices and resource-related considerations for PrEP provision in Title X-funded clinics across the Southern US. Methods: We utilized an explanatory, sequential mixed-methods design to explore models of PrEP implementation in Title X-funded clinics. We conducted a web-based, geographically-targeted survey from February-July 2018, followed by key informant interviews among clinicians and administrators of Title X-funded clinics across 18 states that comprise the Southern US. The survey included questions on implementation of PrEP services. Interviews assessed barriers and facilitators to integrating PrEP into clinic services using implementation-focused constructs from the Consolidated Framework for Implementation Research. A total of 529 individuals completed the survey, representing 285 unique Title X clinics across the South; 39 representatives were purposively sampled from unique clinics to participate in interviews. Results: 109 respondents (20%) reported working in PrEP-providing clinics (62 clinics); 58 were urban-located, and 4 rural-located. Based on interviews from 39 clinics, we classified each clinic by which steps of the PrEP cascade they implemented (1: Screen for HIV risk, 2: Educate, 3: Assess candidacy via labs, 4: Prescribe, 5: Monitor). Of the 39 clinics, 24 conducted at least one step in the PrEP cascade; 8 clinics screened only and referred; 4 screened and educated about PrEP, then referred; 12 provided all steps on-site. Across clinics implementing Step 1, few barriers were identified; having a formal screening tool, having it integrated into electronic medical records, and having support staff to screen prior to appointment were facilitators. For clinics also doing Step 2, PrEP educational materials facilitated the process; clinics not providing education believed they could easily do this step with training and educational resources. Clinics doing Steps 1 & 2 reporte