Pre-implementation planning for scaling up PrEP - Project Summary: This F30 proposal supports a highly motivated MD/PhD candidate at Yale University pursuing rigorous training to become an independent physician-scientist focused on implementation science, HIV prevention, and stakeholder-engaged intervention design. Over four years of funding, the candidate will acquire the frameworks, analytic tools, and field experience needed to develop and test implementation strategies that close the gap between evidence and practice. Although the research is centered in Peru, the project addresses a prevention problem of direct relevance to the US: PrEP remains underused among men who have sex with men (MSM) despite its high effectiveness in preventing HIV. In both Peru and the US, PrEP uptake and persistence are limited by stigma, healthcare mistrust, fragmented service delivery, workforce constraints, difficulty engaging marginalized populations, and uneven integration of prevention services into routine care. These shared barriers make Peru an ideal real-world implementation laboratory for generating knowledge relevant to US HIV prevention programs, especially primary care and safety-net settings seeking scalable strategies to expand PrEP access. The foreign-site research is scientifically justified because Peru is in a critical phase of public-sector PrEP scale-up after national rollout in 2023, when implementation barriers and solutions can be observed as programs move from demonstration projects to broader routine delivery. Peru’s Ministry of Health, community organizations, and HIV prevention stakeholders are actively developing approaches that include digital engagement, differentiated service delivery, and community-based implementation. The trajectory for Peru and the US for MSM are similar making the training and research highly relevant for the US. This evolving environment creates a timely opportunity to study how delivery models can be adapted to the needs, preferences, and lived experiences of MSM while remaining feasible within public clinics. The project uses human-centered design and implementation science to conduct pre-implementation research that will inform feasible, acceptable, and scalable PrEP delivery strategies. These skills have pragmatic benefits for the US. First, the andidate will use nominal group technique with MSM and healthcare providers to identify and prioritize barriers, facilitators, and community-generated solutions for PrEP uptake. Second, the candidate will conduct in-depth interviews with clinicians, primary health center administrators, and Ministry of Health leaders to examine provider-, clinic-, and system-level obstacles to PrEP delivery and implementation feasibility. Third, the candidate will conduct a conjoint-based choice experiment with 600 PrEP-eligible MSM to quantify preferences for alternative PrEP delivery models and identify combinations of program features most likely to increase PrEP use and persistence. Findings will be synthesized using PRISM and mapped to the ERIC taxonomy to guide the selection of future implementation strategies. This project will generate actionable implementation knowledge for Peru and the US while supporting responsible stewardship of NIH resources through clear aims, reproducible methods, and direct relevance to domestic HIV prevention.
