A Multicomponent Approach to Evaluating a Pre-exposure Prophylaxis (PrEP) Implementation Program in Five Agencies in New York

Abstract

Research has shown that pre-exposure prophylaxis (PrEP) is effective for preventing HIV infection. We developed the Targeted PrEP Implementation Program (TPIP), an 18-month project that involved five statewide agencies, to assess the extent to which PrEP could be implemented in "real world" clinical settings. The target population was men who have sex with men at high risk for HIV infection. Data were collected from a variety of sources. Implementing PrEP statewide required facilitating provider capacity, developing resources, and identifying/addressing potential barriers. TPIP focused on three key questions: (a) Can providers identify and retain appropriate candidates for PrEP? (b) Can PrEP participants adhere to daily medication? (c) Can PrEP be delivered as part of a comprehensive/integrated plan? There were 171 participating clients, most of whom successfully incorporated PrEP into their daily routines. After addressing initial barriers, we found that PrEP could be routinely delivered as part of a comprehensive prevention plan.

HIV Preexposure Prophylaxis and Treatment as Prevention — Beliefs and Access Barriers in Men Who Have Sex with Men (MSM) and Transgender Women: A Systematic Review

“…This model has been shown to improve health care entities' ability to identify, recruit, and retain patients. 18 However, information and outreach must align with the unique needs of the intended patient. Studies looking into PrEP awareness in transgender populations find the absence of transinclusive educational and marketing PrEP materials to be a significant barrier to knowledge and access.…”

Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Men Who Have Sex with Men (MSM): A Scoping Review on PrEP Service Delivery and Programming

“…Doblecki-Lewis [67] and Hoffman et al [55] offered a unified approach, urging services to consider 'task-shifting' between primary care staff and HIV specialists. Alternatively, seven studies identified the potential role for 'PrEP navigators'-individuals performing activities to assist potential and current PrEP users through bridging communications with relevant services through information provision and support [62,[68][69][70][71][72][73]. Additional training for service providers was noted as a necessity by 18 studies to ensure effective and sustainable PrEP delivery and programming, which could also provide a solution to bridging the gap between service provider knowledge and the prescribing of PrEP [55,57,59,60,63,65,[67][68][69][72][73][74][75][76][77][78][79][80][81].…”

“…Disruption in routine was also reported [54,93,103,108] but Vaccher et al [103] stated that this could be reduced by carrying spare medication for emergencies. Certain service user groups were identified as being at risk of low PrEP adherence, including those from ethnic minorities, [73,91,111] young MSM, [91] smokers, [111] and those with problematic alcohol or substance use, [91] all of which are exacerbated by systemic disadvantages within society or from an individual's predisposition to risky behaviour.…”

“…For example, Calabrese et al [68] stated that there was a gap for 'the development of curricula and evaluation standards for PrEP-related medical education', whilst Newman et al [120] highlighted the importance of online experiences in bringing together the gay and bisexual male (GBM) PrEP community. The third element is the identification of potential PrEP users [52,61,73,96,108,127]. This could be through existing relationships between the individuals and healthcare providers or counsellors but also through established referral systems.…”

Mind the Gap: HIV Prevention Among Young Black Men Who Have Sex with Men

“…There are several potential sources for financial assistance for these additional costs. Some states have developed PrEP assistance programs to assist with these costs for those at risk for HIV acquisition [105]. Both insurance plans and patient assistance programs including those sponsored by pharmaceutical companies should also be approached to include provisions that ensure basic lab services and follow-up visits will be covered, as continued costs for these services serve as a deterrent for YBMSM to stay engaged in care and adherent to medications.…”