Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework

Abstract Background The ImPrEP México demonstration project is the first to distribute free HIV pre-exposure prophylaxis (PrEP) to men who have sex with men (MSM) and transgender women living in Mexico. In Mexico City, MSM who are also male sex workers (MSWs) face a disproportionately high risk of H...

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Autores principales:	Hemant Kadiamada-Ibarra, Nicola L. Hawley, Sandra G. Sosa-Rubí, Marta Wilson-Barthes, Omar Galárraga, Roxana Rodríguez Franco
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Pre-exposure prophylaxis Men who have sex with men Male sex workers Mexico RE-AIM Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/aad8f668a1374238aaa59813c16ee621
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spelling	oai:doaj.org-article:aad8f668a1374238aaa59813c16ee6212021-11-28T12:12:32ZBarriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework10.1186/s12889-021-12167-91471-2458https://doaj.org/article/aad8f668a1374238aaa59813c16ee6212021-11-01T00:00:00Zhttps://doi.org/10.1186/s12889-021-12167-9https://doaj.org/toc/1471-2458Abstract Background The ImPrEP México demonstration project is the first to distribute free HIV pre-exposure prophylaxis (PrEP) to men who have sex with men (MSM) and transgender women living in Mexico. In Mexico City, MSM who are also male sex workers (MSWs) face a disproportionately high risk of HIV infection. PrEP is highly effective for HIV prevention, yet “real-life” implementation among MSWs is a challenge due to the unique adherence barriers faced by this population. Methods This study uses the RE-AIM implementation science framework to characterize the unique barriers to and facilitators of PrEP uptake among MSWs in Mexico City. We conducted 9 in-depth key informant interviews and 2 focus group discussions with MSWs across 5 clinic and community sites. Qualitative data were analyzed using inductive, open coding approaches from grounded theory. We supplemented findings from the primary qualitative analysis with quantitative indicators derived from ImPrEP program records to describe the current Reach of the ImPrEP program among MSWs in Mexico City and the potential for wider PrEP Adoption among other high-risk populations in Mexico. Results The Reach of the ImPrEP program was 10% of known HIV-negative MSWs in Mexico City. Program Reach was lowest among MSWs who were street-based sex workers, of lower socioeconomic status, migrants from other states and self-identified as heterosexual. Barriers to program Reach included limited PrEP knowledge, HIV-related stigma, and structural barriers; facilitators included in-person program recruitment, patient-centered care, and spread of information through word of mouth among MSWs. Two out of the four eligible institutions had adopted the ImPrEP protocol. Barriers to wider program Adoption included HIV- and sexual identity– related stigma, protocol limitations, and lack of a national policy for PrEP distribution; facilitators of Adoption included existing healthcare infrastructure, sensitized providers, and community support from non-governmental organizations. Conclusions Increasing the ImPrEP program’s Reach among MSWs will depend on improving PrEP education and addressing HIV-related stigma and access barriers. Future Adoption of the ImPrEP program should build on existing clinical infrastructure and community support. Creation of a national policy for PrEP distribution may improve the Reach and Adoption of PrEP among highest-risk populations in Mexico.Hemant Kadiamada-IbarraNicola L. HawleySandra G. Sosa-RubíMarta Wilson-BarthesOmar GalárragaRoxana Rodríguez FrancoBMCarticlePre-exposure prophylaxisMen who have sex with menMale sex workersMexicoRE-AIMPublic aspects of medicineRA1-1270ENBMC Public Health, Vol 21, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Pre-exposure prophylaxis Men who have sex with men Male sex workers Mexico RE-AIM Public aspects of medicine RA1-1270
spellingShingle	Pre-exposure prophylaxis Men who have sex with men Male sex workers Mexico RE-AIM Public aspects of medicine RA1-1270 Hemant Kadiamada-Ibarra Nicola L. Hawley Sandra G. Sosa-Rubí Marta Wilson-Barthes Omar Galárraga Roxana Rodríguez Franco Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework
description	Abstract Background The ImPrEP México demonstration project is the first to distribute free HIV pre-exposure prophylaxis (PrEP) to men who have sex with men (MSM) and transgender women living in Mexico. In Mexico City, MSM who are also male sex workers (MSWs) face a disproportionately high risk of HIV infection. PrEP is highly effective for HIV prevention, yet “real-life” implementation among MSWs is a challenge due to the unique adherence barriers faced by this population. Methods This study uses the RE-AIM implementation science framework to characterize the unique barriers to and facilitators of PrEP uptake among MSWs in Mexico City. We conducted 9 in-depth key informant interviews and 2 focus group discussions with MSWs across 5 clinic and community sites. Qualitative data were analyzed using inductive, open coding approaches from grounded theory. We supplemented findings from the primary qualitative analysis with quantitative indicators derived from ImPrEP program records to describe the current Reach of the ImPrEP program among MSWs in Mexico City and the potential for wider PrEP Adoption among other high-risk populations in Mexico. Results The Reach of the ImPrEP program was 10% of known HIV-negative MSWs in Mexico City. Program Reach was lowest among MSWs who were street-based sex workers, of lower socioeconomic status, migrants from other states and self-identified as heterosexual. Barriers to program Reach included limited PrEP knowledge, HIV-related stigma, and structural barriers; facilitators included in-person program recruitment, patient-centered care, and spread of information through word of mouth among MSWs. Two out of the four eligible institutions had adopted the ImPrEP protocol. Barriers to wider program Adoption included HIV- and sexual identity– related stigma, protocol limitations, and lack of a national policy for PrEP distribution; facilitators of Adoption included existing healthcare infrastructure, sensitized providers, and community support from non-governmental organizations. Conclusions Increasing the ImPrEP program’s Reach among MSWs will depend on improving PrEP education and addressing HIV-related stigma and access barriers. Future Adoption of the ImPrEP program should build on existing clinical infrastructure and community support. Creation of a national policy for PrEP distribution may improve the Reach and Adoption of PrEP among highest-risk populations in Mexico.
format	article
author	Hemant Kadiamada-Ibarra Nicola L. Hawley Sandra G. Sosa-Rubí Marta Wilson-Barthes Omar Galárraga Roxana Rodríguez Franco
author_facet	Hemant Kadiamada-Ibarra Nicola L. Hawley Sandra G. Sosa-Rubí Marta Wilson-Barthes Omar Galárraga Roxana Rodríguez Franco
author_sort	Hemant Kadiamada-Ibarra
title	Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework
title_short	Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework
title_full	Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework
title_fullStr	Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework
title_full_unstemmed	Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework
title_sort	barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in mexico: an application of the re-aim framework
publisher	BMC
publishDate	2021
url	https://doaj.org/article/aad8f668a1374238aaa59813c16ee621
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Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework

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