Abstract
BACKGROUND: Same-day pre-exposure prophylaxis (PrEP) for HIV prevention is a novel tool to increase biomedical prevention access and uptake. Although prior research has identified same-day PrEP as feasible and acceptable, improved understanding of key barriers and facilitators to implementation is needed to optimize impact. METHODS: The Network for Implementation Science in HIV (NISH) examined the implementation of same-day PrEP across 42 Ryan White Part A-D-funded organizations in seven Ending the U.S. HIV Epidemic Initiative priority jurisdictions. We used crisp-set coincidence analysis with six conditions to identify key barriers explaining delayed implementation of same-day PrEP among 38 clinical organizations representing 137 individual clinics where same-day PrEP services were available currently or in the future. RESULTS: Our final model explained ~ 67% of clinical organizations not currently implementing same-day PrEP (n = 8), with a consistency of 80%. This model identified three pathways to non-implementation of same-day PrEP: (1) insurance coverage as a top barrier and insufficient staffing resources as a top barrier; (2) no onsite pharmacy as a top barrier; or (3) provider reticence with same-day PrEP prescribing and insurance coverage as top barriers, and patient demand/(dis)interest in same-day PrEP not being ranked as a top barrier. CONCLUSION: The three identified pathways to delayed implementation of same-day PrEP aid researchers and providers in reverse mapping strategies to enhance and scale up the implementation of same-day PrEP in federally funded clinics in the U.S. Such strategies may include federal and state-level policy changes to expand funding for PrEP coverage, pharmacist-led same-day PrEP implementation, or mail delivery of PrEP prescriptions.