Contributions of Qualitative Methods to Real-Time Implementation Strategy Design: A Case Study Linking Justice Involved Individuals at Risk for HIV to Pre-exposure Prophylaxis

Pre-exposure prophylaxis (PrEP) exemplifies a medical advance that is highly efficacious in reducing an individual's risk of acquiring HIV. However, the use of PrEP remains considerably suboptimal in communities that could benefit from it most, especially in the southern United States where HIV infection rates are highest. We conducted a study using both qualitative methods and implementation science to develop and deploy a multicomponent implementation strategy to link individuals being released from jail to PrEP services in a southern US city. Implementation science supports the translation of evidence-based strategies from clinical knowledge to routine use; simultaneously, qualitative methodologies, given their emphasis on "how" to advance adoption, execution, and sustainment, are critical to implementation science. Our study design for supporting individuals along the "jail-to-community continuum" was rooted in the EPIS (Exploration-Preparation-Implementation-Sustainment) framework and the socioecological model. We began with iterative qualitative data collection involving semi-structured interviews, focus groups, and a community summit with formerly incarcerated individuals, jail clinicians and staff, and members of community organizations who work with justice involved individuals and those who provide PrEP and related services. Following rapid qualitative analysis, we drew on implementation mapping principles to create an action plan that guided the development of implementation strategies for PrEP. Our analysis plan will evaluate the feasibility, effectiveness, and sustainability of our multicomponent implementation strategy. We conclude by offering recommendations based on lessons learned and reflect on the synergistic relationship between qualitative methods and implementation science.