PDF(Pubmed)
Abstract：
Community-based organizations (CBOs) deliver services in culturally-responsive ways, and could effectively partner with health centers to deliver HIV pre-exposure prophylaxis (PrEP) to Latino men who have sex with men (LMSM). However, few such models exist. We conducted a planning study in collaboration with three CBOs serving LMSM to identify optimal PrEP delivery strategies for health centers and CBOs to implement jointly. We established a Community Expert Panel (CEP) of eight client-facing CBO and health center staff. Over 6 months, the panel met monthly to identify collaborative strategies for PrEP delivery, using a modified Delphi method consisting of the following steps: (1) brainstorming strategies; (2) rating strategies on acceptability, appropriateness and feasibility; (3) review of data from qualitative focus group discussions with CBO clients; and (4) final strategy selection. The panel initially identified 25 potential strategies spread across three categories: improving communication between health centers and CBOs; using low-barrier PrEP options (e.g. telemedicine), and developing locally-relevant, culturally-sensitive outreach materials. Focus groups with CBO clients highlighted a desire for flexible options for PrEP-related care and emphasized trust in CBOs. The final package of strategies consisted of: (1) a web-based referral tool; (2) telemedicine appointments; (3) geographically-convenient options for lab specimen collection; (4) tailored print and social media; and (5) regular coaching sessions with CBO staff. Through a community-engaged process, we identified a package of PrEP delivery strategies that CBOs and health centers can implement in partnership, which have the potential to overcome barriers to PrEP for LMSM.
摘要：
社区组织(CBO)以文化响应的方式提供服务，并且可以有效地与卫生中心合作，向与男性发生性关系的拉丁裔男性（LMSM）提供HIV暴露前预防（PrEP）。然而,这样的模式很少存在。我们与为LMSM服务的三个CBO合作进行了一项计划研究，以确定医疗中心和CBO共同实施的最佳PrEP交付策略。我们成立了一个由八名面向客户的CBO和卫生中心工作人员组成的社区专家小组（CEP）。超过6个月,小组每月开会，以确定PrEP交付的协作策略，使用改进的德尔菲法，包括以下步骤：(1)头脑风暴策略；(2)可接受性评级策略，适当性和可行性；（3）审查来自与CBO客户的定性焦点小组讨论的数据；以及（4）最终策略选择。小组最初确定了25种潜在策略，分布在三个类别中：改善卫生中心和社区组织之间的沟通；使用低门槛的PrEP选项（例如远程医疗），发展与当地相关的，文化敏感的外展材料。与CBO客户的焦点小组强调了对与PrEP相关的护理的灵活选择的愿望，并强调了对CBO的信任。最后一揽子战略包括：（1）基于网络的转诊工具；（2）远程医疗预约；（3）实验室标本收集的地理便利选择；（4）量身定制的印刷和社交媒体；（5）与CBO工作人员的定期辅导会议。通过社区参与的过程，我们确定了CBO和医疗中心可以合作实施的一系列PrEP交付策略，有可能克服LMSM准备工作的障碍。
