Using a positive deviance approach for PrEP implementation among Latino populations in Puerto Rico and Washington, DC

Carlos Rodriguez Diaz
September 21, 2022

Carlos E. Rodríguez-Díaz, PhD, MPHE, MCHES (GW) has received an NIH CFAR Administrative Supplement entitled, “Using a positive deviance approach for PrEP implementation among Latino populations in Puerto Rico and Washington, DC”. 

Over the last three decades, promising socio-behavioral and biomedical prevention strategies have significantly contributed to ending the HIV epidemic. The current national initiative, "Ending the HIV Epidemic: A Plan for America (EHE)," prioritizes implementing evidence-based strategies in the geographical locations and populations most affected by HIV. San Juan, Puerto Rico (P.R.) and Washington, District of Columbia (D.C.) are Phase 1 Priority Jurisdictions identified in the initiative. P.R. and D.C. share socio-political experiences (non-state jurisdictions) for implementing HIV prevention services. On the other hand, PrEP uptake in P.R. and D.C. is different; D.C. is among the top five jurisdictions for PrEP uptake, and P.R. has the lowest PrEP uptake in the United States (U.S.). These circumstances, among others, place these jurisdictions in a unique position to create generalizable implementation research knowledge to achieve the goals of the EHE initiative. Scientists have documented that retention in PrEP care is consistently suboptimal, particularly true for communities of color. The same populations at greater risk for HIV infection are failing to benefit from a prevention strategy that can dramatically change the HIV outcomes in their communities. Researchers have already documented challenges for the successful implementation of PrEP services among Latinos. However, the PrEP uptake among Latinos is not increasing significantly. Amid this public health problem, some organizations successfully provide PrEP care, but, in general, research has focused on documenting the barriers to PrEP uptake. In contrast, we want to pay attention to "what is working". By integrating a "positive deviance" approach, we presume that the knowledge about "what works" is available in existing organizations that demonstrate exceptional performance. For this project, the goal is to document and promote practices for the successful implementation of PrEP among Latino populations. Successful implementation of PrEP services will be determined based on PrEP uptake and persistence. We will achieve this goal using a multiphase mixed-method design, community-based participatory research (CBPR) approach, and the Health Equity Implementation Framework and through the following aims: 1) Determine "positive deviants," i.e., practices that are being successful for PrEP implementation for Latino populations in Puerto Rico and Washington, DC, and 2) Explore the appropriateness, feasibility, and acceptability of positive deviant practices for successful PrEP implementation with Latino populations.