Date of Conferral

2-18-2026

Degree

Ph.D.

School

Health Sciences

Advisor

Harrison Ndetan

Abstract

Pre-exposure prophylactic care delivery innovations (PCDI) are critical to the Ending the HIV Epidemic (EHE) initiative. While individual studies have examined isolated factors such as patient awareness, provider willingness to prescribe, and cost-effectiveness, few have synthesized these findings into a unified framework explaining how structural social, political, and economic determinants jointly influence PCDI. Prior literature remains fragmented, emphasizing behavioral or programmatic variables rather than systemic structures. This meta-analysis was done to examine how structural determinants independently and collectively influence PCDI across the 47 U.S. EHE jurisdictions. Guided by the consolidated framework for implementation research and Rogers’s diffusion of innovations theory, a PRISMA 2020 search identified 3,214 records. Forty-seven studies met inclusion criteria, representing N = 46,450 participants. Data were analyzed using inverse-variance weighting under fixed- and random-effects models in SPSS v30. Results indicated a moderate positive association between social determinants and PCDI (ES = 0.82, p = .003). Political (ES = 1.03, p = .001) and economic determinants (ES = 1.01, p = .002) also showed positive associations. The combined determinant model yielded a smaller association with PCDI (ES = 0.06, p < .001). These findings support Walden’s social change mission by demonstrating that strengthening structural determinants can improve equitable access to PCDI in the 47 underserved U.S. EHE jurisdictions.

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