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An Implementation Science Study About Sexual History Screening and Dissemination of PrEP within a Multi-site Federally Qualified Health Center

Gagnon, Kelly (2022) An Implementation Science Study About Sexual History Screening and Dissemination of PrEP within a Multi-site Federally Qualified Health Center. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Sexual history screening (SHS) is an evidence-based guideline recommended to identify patients’ risk of adverse sexual health outcomes, including sexually transmitted infections (STIs), which is not routinely or consistently implemented in healthcare settings. Lack of SHS prevents clinical providers from systematically identifying patients at risk of STIs who may benefit from harm reduction methods, such as pre-exposure prophylaxis (PrEP). This dissertation analyzed patient data from the electronic health record and staff survey and interview data from a multi-site Federally Qualified Health Center (FQHC) in Connecticut. In the first analysis, younger patients and patients whose primary language was not English were significantly less likely to have SHS documented in their medical charts (AOR= 0.99, 95% CI: 0.99, 0.99 and AOR= 0.91, 95% CI: 0.85, 0.97), while patients who were gay, lesbian, and/or homosexual and cisgender women were significantly more likely (AOR= 1.23, 95% CI: 1.04, 1.45 and AOR= 1.01, 95% CI: 1.04, 1.16). PCPs who were cisgender women were more likely to have patients with documented SHS (AOR= 1.80, 95% CI: 1.00, 3.21). The second analysis found SHS documented in the medical chart was associated with a higher proportion of PrEP prescription duration (IRR = 1.44, 95% CI: 1.17, 1.77). There was no significant effect for referral to the PrEP Navigator or having both SHS documented in the medical chart and a referral to the PrEP Navigator. Lastly, the third study found that barriers to implementation of SHS and PrEP services were: external reimbursement and payment policies, time, insurance and finances, and variation by site. In contrast, facilitators were organizational culture, PrEP support staff, and the patient-provider relationship. In addition to facilitators and barriers, influential factors reflected the influence of the structure of SHS and PrEP services and providers’ knowledge of and attitudes. Our findings indicate identify factors associated with the ability to implement SHS and PrEP services with adult FQHC patients. These results provide preliminary evidence of factors that are necessary to address to improve the implementation of SHS and PrEP services among adult patients in a large FQHC setting.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Gagnon, Kellykeg118@pitt.edukeg118
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairHawk, Marymary.hawk@pitt.edumeh96
Committee MemberCoulter,
Committee MemberJames, Eganjee48@pitt.edujee48
Committee MemberKen, Hohok2@upmc.eduhok2
Date: 10 May 2022
Date Type: Publication
Defense Date: 21 February 2022
Approval Date: 10 May 2022
Submission Date: 31 March 2022
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 155
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: implementation science; sexual health; primary care; public health
Date Deposited: 10 May 2022 18:20
Last Modified: 10 May 2023 05:15


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