Determinants of Adoption, Implementation, Reach, and Sustainability of PrEP Services in a Sexual Health Clinic in Canada: A Qualitative Analysis Using CFIR and REAIM

Abstract

Background: Sexual health clinics are promising settings for HIV pre-exposure prophylaxis (PrEP), yet implementation in mixed urban–rural regions remains underexplored. This study evaluated the implementation of a PrEP clinic in a mid-sized Ontario region within a public health setting, including adoption, implementation model, reach, perceived effectiveness, and key determinants. Methods: Guided by RE-AIM and the Consolidated Framework for Implementation Research (CFIR), we conducted an evaluation using process-mapping and interviews with staff (n = 7) and clients (n = 5). Results: Adoption and implementation were supported by strong leadership, organizational culture, provider knowledge, and perceptions of PrEP as effective and simple. The clinic demonstrated high fidelity, sustained service delivery, and meaningful client engagement. However, reach remained uneven, with the program primarily serving insured populations. Medication costs, poverty, stigma, and geographic barriers limited equitable access. Conclusions: Sexual health clinics can sustainably deliver PrEP, but equitable scale-up requires structural reforms, diversified delivery models, and stronger community partnerships.