Advancing the HIV Pre-Exposure Prophylaxis Continuum: A Collaboration Between a Public Health Department and a Federally Qualified Health Center in the Southern United States

Clement, Meredith E.; Johnston, Barbara; Eagle, C. C. P.; Taylor, D. Robin; Rosengren, A. Lina; Goldstein, Benjamin A.; Seña, Arlene C.

doi:10.1089/apc.2019.0054

Cited by 23 publications

(17 citation statements)

References 26 publications

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“…PH has significant potential to implement PrEP, and in a recent survey, 45% of PH departments anticipated expanding their future engagement in PrEP services. 11,12,21,22 These findings support local PH departments taking on broader roles in PrEP care, including through collaborations with telehealth or other programs.…”

Section: Discussionmentioning

confidence: 54%

“…Research on PrEP implementation in PH settings and best practices for collaboration is still in the early stages. 12,21 The findings point to the tensions between the dual needs of adaptability and standardization and the importance of managing this balance when planning scalability.…”

Section: Discussionmentioning

confidence: 99%

“…The combination of client referral in PH settings and PrEP delivery through regional telehealth services has the potential to improve PrEP access in rural and small urban communities, but little is known about the best practices for integrating these services and for facilitating collaboration between local PH departments and regional TelePrEP programs. 11,12 Iowa TelePrEP is a PH-partnered, direct-to-client telehealth model developed through a partnership between the Iowa Department of Public Health (IDPH) and the University of Iowa. 4 Designed to improve PrEP access in rural and small urban areas by overcoming the barriers related to distance and stigma, TelePrEP combines (1) referral of PH clients from IDPH's statewide network of CTR and DIS/PS services, (2) centralized telenavigation for client linkage to TelePrEP or community PrEP providers as desired, (3) PrEP counseling and prescribing during telehealth visits provided by University of Iowa pharmacists working within a collaborative practice model, (4) laboratory testing conducted within the existing statewide network of PH sites, and (5) PrEP medication delivery by mail or through local pharmacies (Appendix Figure 1, available online).…”

Section: Introductionmentioning

confidence: 99%

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Bringing Iowa TelePrEP to Scale: A Qualitative Evaluation

Chasco

Shafer²,

Dillon

et al. 2021

American Journal of Preventive Medicine

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Introduction: Regional partnerships between public health organizations and telehealth programs have the potential to expand access to HIV pre-exposure prophylaxis in rural and small urban areas. However, little is known about the best practices for such partnerships. Iowa TelePrEP, a regional public health-partnered telehealth model created by the Iowa Department of Public Health and the University of Iowa, expanded statewide between 2017 and 2019. This qualitative evaluation assessed the barriers and facilitators to statewide expansion and the lessons learned.Methods: Key informants from public health partners across Iowa participated in a focus group and interviews between May 2019 and November 2020. Public health partners included local health departments and disease intervention specialist/partner services programs. Qualitative data were transcribed and thematically coded. Program documents and routinely collected reporting data were reviewed to provide the context for qualitative findings. Data were analyzed in 2020.Results: TelePrEP expanded in 4 phases through partnerships with 12 public health partners. Public health partners referred 708 clients with pre-exposure prophylaxis indications to telenavigation; of these, 258 were navigated to TelePrEP, and 167 initiated pre-exposure prophylaxis. The facilitators of expansion included early public health partner engagement, model acceptability and inclusion of a navigator, and adaptability to local public health partner settings. The barriers included the need to adapt communication and processes to varying public health partners, difficulty in engaging underserved populations, the COVID-19 pandemic, and perceived gaps in understanding client outcomes.Conclusions: Partnerships between regional telehealth programs and local health departments can expand to the state level and increase the capacity to implement pre-exposure prophylaxis in rural and small urban settings. Partnerships should consider how to balance program adaptability to local public health partners with standardization and scalability.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bringing Iowa TelePrEP to Scale: A Qualitative Evaluation

Chasco

Shafer²,

Dillon

et al. 2021

American Journal of Preventive Medicine

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“…These data, unfortunately, are not surprising and are consistent with other literature on PrEP referral systems. [4][5][6] Yet there is some promise in our findings, including the potential benefit of navigator support. Few clients attended their initial PrEP appointment when the referral occurred with no immediate contact with the PrEP clinic navigator (''card only'').…”

Section: Discussionmentioning

confidence: 84%

“…Yet prior studies have shown that referral systems-from SHC to PrEP clinic-can result in a drop-off of the care continuum from those willing and interested to those who successfully complete an initial PrEP appointment. [4][5][6] The objective of this study was to evaluate the efficacy of a PrEP referral process from an SHC to a co-located PrEP clinic, including the impact of referral method on likelihood of attending the initial PrEP visit.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an HIV Pre-Exposure Prophylaxis Referral System: From Sexual Health Center to Federally Qualified Health Center Pre-Exposure Prophylaxis Clinic

Lillis

Beckford

Fegley³

et al. 2021

AIDS Patient Care and STDs

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Innovative delivery strategies are needed to facilitate access to HIV pre-exposure prophylaxis (PrEP). The objective of this study was to evaluate a navigator-facilitated PrEP referral process from a sexual health center (SHC) to a co-located PrEP clinic as an alternative delivery model. Electronic health record (EHR) data were used to calculate the number of clients seen at the SHC in 2019. Charts were manually reviewed to determine whether a PrEP clinic referral was made and document type of referral method: face-to-face appointment scheduling with the navigator (warm handoff), EHR messaging to navigator to schedule the appointment at a later time (EHR message), or provision of navigator's contact information to the client (card only). In 2019, 2481 unique potentially PrEP-eligible clients were seen at the SHC; 220 (9%) received a PrEP referral. Of referred clients, median age was 30 years (interquartile range, 24-34), 182 (83%) were male, 89 (40%) were non-Hispanic Black, and 24 (11%) were Latinx. In total, 94/220 (43%) referred clients attended an initial PrEP visit with a provider, and the proportion attending by referral method was 81%, 36%, and 27% for warm handoff, EHR message, and card only, respectively ( p < 0.0001). Despite colocation of these two clinics, there were significant drop-offs along the PrEP care continuum for this referral system. Warm handoff was the most effective referral method, but further efforts are needed to understand barriers to referral. Implementation of same-day PrEP services at SHCs is one potential solution to engaging additional clients.

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HIV Prevention, Care, and Treatment Among Black Men Who Have Sex with Men (MSM)

Wilton

2020

HIV in US Communities of Color

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Advancing the HIV Pre-Exposure Prophylaxis Continuum: A Collaboration Between a Public Health Department and a Federally Qualified Health Center in the Southern United States

Cited by 23 publications

References 26 publications

Bringing Iowa TelePrEP to Scale: A Qualitative Evaluation

Bringing Iowa TelePrEP to Scale: A Qualitative Evaluation

Evaluation of an HIV Pre-Exposure Prophylaxis Referral System: From Sexual Health Center to Federally Qualified Health Center Pre-Exposure Prophylaxis Clinic

HIV Prevention, Care, and Treatment Among Black Men Who Have Sex with Men (MSM)

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