Understanding adaptive responses in PrEP service delivery in Belgian HIV clinics: a multiple case study using an...

Area of Science:

• Public Health
• Infectious Disease Management
• Healthcare Services Research

Background:

• Oral HIV pre-exposure prophylaxis (PrEP) is crucial for reducing HIV transmission in Belgium.
• Current PrEP services are mainly in specialized clinical settings.
• Limited understanding of implementation processes and contextual factors affecting PrEP delivery.

Purpose of the Study:

• To examine factors influencing healthcare providers' adaptive responses during PrEP service implementation in Belgian HIV clinics.
• To understand how local contexts shape the adaptation of PrEP care delivery.

Main Methods:

• Qualitative multiple case study involving eight HIV clinics.
• 36 semi-structured interviews with PrEP care providers (physicians, nurses, psychologists).
• 50 hours of healthcare setting and clinical interaction observations.
• Thematic analysis guided by extended Normalisation Process Theory.

Main Results:

• Providers demonstrated adaptive capacity to manage increased workload and individual user needs.
• Clinic structures and processes were reorganized for efficient PrEP care delivery.
• Adaptations included flexible prescribing norms, task-shifting (physician to nurse), and enhanced interprofessional collaboration (sexologists, psychologists, family physicians).
• Nurses played a key role in addressing non-medical and psychosocial needs, alleviating clinic burden.

Conclusions:

• PrEP care implementation is a complex undertaking requiring significant provider adaptation for seamless integration.
• Policies and guidelines for PrEP implementation should be flexible and tailored to local health system needs.
• Successful integration of PrEP services depends on adaptive capacity and contextual tailoring.