Submission ID 131629
| Issue/Objective | A lack of culturally competent providers is recognized as a major health equity barrier to engaging and retaining Black men who have sex with men (MSM) in HIV Pre-exposure prophylaxis care. There is no Canadian-specific evidence-based practice to improve providers' cultural competency for HIV PrEP. We identified an evidence-based practice to enhance providers' cultural competence in HIV Pre-exposure prophylaxis, adapted and pilot-tested the intervention to evaluate its acceptability, appropriateness, feasibility, and service outcomes. |
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| Methodology/Approach | Through expert recommendation, we identified an evidence-based practice developed by the Center for Community Practice at the University of Rochester, New York: Culturally Responsive PrEP Services for Black MSM (CR-PrEP). CR-PrEP is a facility-level training and quality improvement intervention. Using the seven-step ADAPT-ITT framework, we adapted the intervention to the Canadian context, guided by recommendations from key stakeholders and topical experts. We trained facilitators to deliver the intervention, conducted a pilot implementation with eleven clinical and service providers in Toronto, guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Implementation outcomes were assessed using the psychometric measures of Weiner et al., while service outcomes were determined by reviewing service outcome documentation. |
| Results | The adaptation process generated 37 materials that together formed the intervention manual. During the pilot rollout across 11 participating organizations, all outcomes received high ratings (average scores of 17.7/20 for acceptability, 17.7/20 for appropriateness, and 17.0/20 for feasibility), indicating strong perceived fit and usability of the adapted intervention. Service outcome review shows that implementing the CR PrEP intervention achieved a 30% retention rate of Black MSM in PrEP care within 18 months of the intervention, based on data from one of the clinical sites reporting service outcomes. |
| Discussion/Conclusion | A culturally responsive HIV pre-exposure prophylaxis intervention (CR-PrEP) demonstrates practical fit and usability among clinical and service providers, as well as the potential to increase retention of Black MSM in PrEP care. This implementation trial illustrates a means of culturally responsive accountability amongst sexual health clinical providers towards their Black clients. |
| Presenters and Affiliations | Wale Ajiboye REACH Nexus, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto Hannah Zuta REACH Nexus, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto Debapriya Chakraborty REACH Nexus, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto Jemal Demeke Wellesley Institute LaRon Nelson Yale University |
