Participatory System Dynamics to Enhance PrEP Access in Bronx, NY

ABSTRACT The Bronx, NY is one of the areas most impacted by HIV in the U.S. Improving access to and use of pre-exposure prophylaxis (PrEP) requires care delivery strategies tailored to the unique needs and circumstances of the people most impacted by HIV. There is broad consensus that ending the HIV epidemic requires creative, community-engaged, participatory approaches. One such approach is system dynamics modeling, an action research methodology to identify practicable, effective solutions to complex problems by examining both the dynamic relationships between their underlying factors and the potential impact of interventions to address these problems. In the proposed study, together with a group of Bronx-based community and implementer stakeholders, we will undertake a system dynamics-informed implementation mapping process to identify promising PrEP implementation strategies. This work will be guided by two implementation science frameworks: the Consolidated Framework for Implementation Research (CFIR) and Proctor’s Taxonomy of Implementation Outcomes. In the R21 phase of this proposal, we aim to: (1) co-design and validate a system dynamics model delineating factors influencing PrEP engagement, and (2) use the resultant model to determine the potential effectiveness of one or more prioritized strategies to improve PrEP engagement. If we achieve pre-specified R21 milestones, in the R33 phase, our specific aim is to: (3) pilot test the most promising strategies, working with stakeholders to operationalize and implement the strategies and measure their impact. The findings from this participatory, community-engaged study will provide timely and practical data that will advance our understanding of how to address gaps in PrEP uptake and ultimately HIV transmission rates.