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In Mexico City, MSM who are also male sex workers (MSWs) face a disproportionately high risk of HIV infection. PrEP is highly effective for HIV prevention, yet \u201creal-life\u201d implementation among MSWs is a challenge due to the unique adherence barriers faced by this population.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This study uses the <jats:italic>RE-AIM<\/jats:italic> implementation science framework to characterize the unique barriers to and facilitators of PrEP uptake among MSWs in Mexico City. We conducted 9 in-depth key informant interviews and 2 focus group discussions with MSWs across 5 clinic and community sites. Qualitative data were analyzed using inductive, open coding approaches from grounded theory. We supplemented findings from the primary qualitative analysis with quantitative indicators derived from ImPrEP program records to describe the current <jats:italic>Reach<\/jats:italic> of the ImPrEP program among MSWs in Mexico City and the potential for wider PrEP <jats:italic>Adoption<\/jats:italic> among other high-risk populations in Mexico.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The <jats:italic>Reach<\/jats:italic> of the ImPrEP program was 10% of known HIV-negative MSWs in Mexico City. Program <jats:italic>Reach<\/jats:italic> was lowest among MSWs who were street-based sex workers, of lower socioeconomic status, migrants from other states and self-identified as heterosexual. Barriers to program <jats:italic>Reach<\/jats:italic> included limited PrEP knowledge, HIV-related stigma, and structural barriers; facilitators included in-person program recruitment, patient-centered care, and spread of information through word of mouth among MSWs. Two out of the four eligible institutions had adopted the ImPrEP protocol. Barriers to wider program <jats:italic>Adoption<\/jats:italic> included HIV- and sexual identity\u2013 related stigma, protocol limitations, and lack of a national policy for PrEP distribution; facilitators of <jats:italic>Adoption<\/jats:italic> included existing healthcare infrastructure, sensitized providers, and community support from non-governmental organizations.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Increasing the ImPrEP program\u2019s <jats:italic>Reach<\/jats:italic> among MSWs will depend on improving PrEP education and addressing HIV-related stigma and access barriers. Future <jats:italic>Adoption<\/jats:italic> of the ImPrEP program should build on existing clinical infrastructure and community support. Creation of a national policy for PrEP distribution may improve the <jats:italic>Reach<\/jats:italic> and <jats:italic>Adoption<\/jats:italic> of PrEP among highest-risk populations in Mexico.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12889-021-12167-9","type":"journal-article","created":{"date-parts":[[2021,11,27]],"date-time":"2021-11-27T09:02:41Z","timestamp":1638003761000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework"],"prefix":"10.1186","volume":"21","author":[{"given":"Hemant","family":"Kadiamada-Ibarra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola L.","family":"Hawley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra G.","family":"Sosa-Rub\u00ed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Wilson-Barthes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana Rodr\u00edguez","family":"Franco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Gal\u00e1rraga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,27]]},"reference":[{"key":"12167_CR1","unstructured":"Government of Mexico. 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Protocols for both in-depth interviews with key informants and focus groups with male sex workers were reviewed and approved by the National Institute of Public Health (INSP) Ethics Committee in Cuernavaca, Mexico (CI\/2019\/147).All study participants provided written informed consent prior to study participation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None of the authors has a commercial or associative interest that presents a conflict of interest with this work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"2174"}}