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Open Access 29-01-2025 | Human Immunodeficiency Virus | Original Paper

Implementation Determinants of PrEP and Behavioral Health Treatment Referral among HIV Test Counselors

Authors: Audrey Harkness, Vanessa Morales, Kyle Grealis, Nequiel Reyes, Daniel J. Feaster, Steven Safren, DeAnne Turner, Raymond R. Balise

Published in: AIDS and Behavior

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Abstract

Pre-exposure prophylaxis (PrEP), an effective biomedical prevention intervention, is not sufficiently reaching populations experiencing high HIV incidence. Behavioral health (BH) treatment addressing mental health and substance use similarly requires increased reach to HIV-affected populations. HIV testing is an opportunity to refer individuals to PrEP and BH treatment. This study, conducted in Miami-Dade County, FL, a domestic HIV epicenter, aimed to assess (1) self-reported rates at which HIV test counselors refer clients to PrEP and BH treatment, (2) barriers and facilitators to PrEP and BH treatment referral, and (3) the relationship between barriers and facilitators and test counselors’ referral rates. Among 127 HIV test counselors, the average PrEP referral rate was 63.8% (SD = 41.5) of those potentially meeting PrEP indications. Insufficient time was associated with lower PrEP referral (OR: 0.64, 95% CI: 0.42–0.99, p = 0.023) and training in PrEP screening was associated with higher rates of PrEP referral (OR: 1.27, 95% CI: 0.98–1.64, p = 0.034). The average BH treatment referral rate was 52.7% (SD = 44.4) of clients who the counselor felt would potentially benefit from treatment. Counselors lacking knowledge of screening (OR: 0.4, 95% CI: 0.2–0.78, p = 0.004), referral procedures (OR: 0.45, 95% CI: 0.23–0.87, p = 0.008), or locations to refer clients (OR: 0.47, 95% CI: 0.25–0.86, p = 0.008), as well as those with higher caseloads (OR: 0.998, 95% CI: 0.997–0.999, p < 0.001) were less likely to refer for BH. Training in substance use screening (OR: 1.26, 95% CI: 0.96–1.64, p = 0.046) and referral (OR: 1.28, 95% CI: 0.99–1.66, p = 0.029) were associated with increased BH referral. Implementation strategies are needed to address key barriers to PrEP and BH referrals in HIV testing contexts.
Footnotes
1
The exception to the compensation was participants from one organization that had a policy against research incentives.
 
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Metadata
Title
Implementation Determinants of PrEP and Behavioral Health Treatment Referral among HIV Test Counselors
Authors
Audrey Harkness
Vanessa Morales
Kyle Grealis
Nequiel Reyes
Daniel J. Feaster
Steven Safren
DeAnne Turner
Raymond R. Balise
Publication date
29-01-2025
Publisher
Springer US
Published in
AIDS and Behavior
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-025-04620-2

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