Facilitators and Barriers to Pre-exposure Prophylaxis (PrEP) Provision in a Midwest College Health Center: A Mixed-Method Study

The use of pre-exposure prophylaxis (PrEP), an effective medication for preventing HIV transmission, in adolescent and young adult (AYA) populations is low. Prior studies of PrEP implementation identified facilitators and barriers to provision, but no study has focused on PrEP in college health centers. The purpose of this mixed methods study was to evaluate the PrEP provision context in a Midwest college health center.

Guided by the Consolidated Framework for Implementation Research (CFIR), eight students completed semi-structured interviews and 15 service providers completed surveys between August 2022 and September 2023. Responses were transcribed, coded, and analyzed using a convergent parallel approach.

The responses from both the providers and the students indicated that the college health center has a strong PrEP climate. Providers overall were confident in PrEP’s evidence-base and held positive attitudes about PrEP. Students affirmed in their interviews that the providers were non-judgmental and helped to mitigate the barriers associated with getting PrEP. Burdens (such as paying for PrEP) remained challenging to navigate even with support from the providers whereas providers often demonstrated limited knowledge of PrEP.

This study provides potential targets for improving PrEP provision at a Midwest college health center as well as guidance for evaluating other college health centers’ PrEP implementation climate.

Additional trainings as well as a dedicated PrEP champion at the college health center would improve PrEP provision as would policies that mandate stronger linkages to community PrEP provision services.