JMIR Publications

ABSTRACT

Background:

Although long-acting injectable cabotegravir (CAB-LA) preexposure prophylaxis (PrEP) has proven efficacious for HIV prevention in clinical trials, additional research is needed to guide effective implementation in real world settings. Formative work with community members and health care providers (HCP) is especially important to provide insight to the needs and contexts of specific populations, reveal potential obstacles to service implementation, mitigate barriers and leverage facilitators, increasing the likelihood of achieving the desired outcomes.

Objective:

This article describes our formative work to develop an initial implementation package for CAB-LA for PrEP within the ImPrEP CAB-Brasil study.

Methods:

ImPrEP CAB-Brasil is an implementation study of same-day delivery of CAB-LA PrEP for young sexual and gender minorities (SGM; aged 18-30 years) in six existing oral PrEP public health clinics. We conducted formative research to prepare for the implementation of ImPrEP CAB-Brasil through (1) community mobilization; (2) process mapping; and (3) focus group discussions with young SGM (N=92) and HCP (N=20) to identify initial perceptions of facilitators and barriors for the implementation of CAB-LA PrEP implementation, refine an mHealth tool to support PrEP choice, and evaluate the acceptability of using a text message appointment reminder intervention through WhatsApp.

Results:

A community mobilization team composed of 34 SGM community leaders collaborated in refining a prototype for an mHealth intervention and contributed to the planning of peer education activities. We also engaged with HCP to create three process maps for each site to describe the initial inclusion visit, follow-up visits, and laboratory flow. The main challenge identified for same-day CAB-LA PrEP delivery was the duration of clinic visits due to a high number of laboratory and HIV counseling steps necessary. Proposed solutions included having point-of-care HIV rapid tests (with additional training) instead of laboratory tests and need for additional counseling staff. Identified barriers for CAB-LA PrEP implementation through focus group discussions incorporated the training of HCP, creating a stigma-free environment, and supporting adherence to injection appointments. mHealth educational tool and WhatsApp reminder text messages were highly acceptable by SGM and HCP, indicating their potential to support PrEP choice and adherance. Focus group participants identified stigma against SGM and persons using PrEP as barriers to injecta,ble PrEP implementation. Content analysis on cultural appropriateness of language and overall clarity of the material contributed to the refinement of the mHealth technology.

Conclusions:

Structured formative work with SGM persons and health providers generated important refinements to context-specific materials and plans to launch ImPrEP CAB-Brasil in public health clinics. Ongoing implementation monitoring will use the process maps to identify additional barriers and potential solutions to CAB-LA PrEP same-day delivery. Summative evaluations are needed to measure the effectiveness of the mHealth educational intervention to support PrEP choice and the use of WhatsApp appointment reminders. Clinical Trial: ClinicalTrials.gov NCT05515770 (29-AUG-2022)