PrOTECT AL: PrEP Optimization Through Enhanced Continuum Tracking

About This Grant

HIV disproportionately affects the Southern United States. Development of effective interventions to scale up and sustain HIV pre-exposure prophylaxis (PrEP) utilization is essential to change the face of the epidemic. Defining the PrEP Care Continuum in geographic “hot spots” throughout the South will expedite deployment of evidence-based practices, developed in response to gaps coverage and tailored for priority populations, by clearly defining gaps in care. It is for this exact reason that the Alabama Department of Public Health and Alabama Quality Management Group (AQMG), Ryan White Clinics across the state, have prioritized expansion of PrEP services in high HIV incidence areas as a strategic goal for the state. A needs assessment to determine desired implementation strategies to utilize data in defining the state’s PrEP Care Continuum (preliminary work funded through Ending the HIV Epidemic CFAR Supplements) resulted in our research proposal to develop PrOTECT AL (PrEP Optimization Through Enhanced Continuum Tracking) with the following aims: (1) Sub-aim1a – Refine the PrOTECT AL dashboard with clinic performance metrics, including PrEP coverage scores (i.e., number of persons prescribed PrEP compared to those with an indication) AND Sub-aim 1b – Assess on-site readiness assessments to improve adoption of the dashboard by collaborating sites, (2) Evaluate implementation outcomes associated with deployment of PrOTECT AL, grounded in RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance implementation framework) AND (3) Evaluate the public health impact of PrOTECT AL by conducting an interrupted time-series study of local PrEP to Need Ratio (i.e. PNR – the number of PrEP users divided by new HIV diagnoses) and PrEP coverage. This multi-phase mixed methods implementation study will engage key-informants from the seven collaborating AQMG sites (5 key-informants per site, n = 35) and is guided by a unified implementation logic research model grounded in the Consolidated Framework for Implementation Research and RE-AIM. This phase will focus on improving Adoption and Implementation of PrOTECT AL, by engaging community partners in refining and evaluating our data platform and dashboard, as well as its Reach in improving PrEP coverage in prescriptions. The study will be able to assess whether implementing the PrOTECT AL platform is associated with improvements in PNR over time, above and beyond recent secular trends. The proposed grant is responsive to the “Prevent Pillar” of the National EHE and reflects high priority research topics for the National Institute of Health. This research will lay the groundwork for understanding how to improve the effectiveness of data dashboards in changing clinical practice and improving health outcomes. Future work will focus on how to engage community and populations facing disparities in accessing data dashboards to inform HIV prevention behavior as well as expansion of partnerships to other Southern states.