Anticipated Determinants and Strategies Supporting Same-Day HIV Pre-Exposure Prophylaxis Implementation During...

Same-day HIV pre-exposure prophylaxis (PrEP) implementation remains challenging, especially in high-volume settings like emergency departments (EDs). To guide program design and implementation efforts, we qualitatively explored anticipated implementation determinants and accompanying strategies facilitating same-day PrEP implementation in an urban Kenyan ED.

In 2024-2025, we conducted a cross-sectional qualitative study involving key informant interviews (N=20) with physicians, nurses, pharmacists, HIV counselors, and administrators at Kenyatta National Hospital (KNH) in Nairobi, Kenya. Using the Consolidated Framework for Implementation Research (CFIR), we explored theorized determinants of ED-based PrEP implementation and subsequently mapped identified determinants to requisite implementation strategies, articulated in the Expert Recommendations for Implementing Change (ERIC) taxonomy, using a CFIR-ERIC matching approach.

The most salient barriers to same-day, ED-based PrEP implementation emerged within the Inner Setting domain, including space limitations, staffing shortages, as well as suboptimal capacity and provider competency to deliver PrEP in emergency care settings. Some providers perceived HIV services and emergency care as incongruous, impeding integration of PrEP into ED-based clinical workflows. Anticipated patient stigma, perceived incompatibility of PrEP services with status-neutral care environments, and opaque clinical/practice guidelines also constrained ED-based PrEP implementation. Identified facilitators included existing leadership involvement in clinical decision-making, existing interdepartmental collaborations, and provider enthusiasm to reach younger persons and key populations with PrEP in the ED. ERIC strategies mapping to all five CFIR domains included: conducting ongoing training, promoting network weaving, and tailoring strategies.

Findings indicate strategies like longitudinal training, standardizing screening with integrated systems, and configuration of setting-specific guidelines/protocols may enhance same-day, ED-based PrEP programming.