Bringing Iowa TelePrEP to Scale: A Qualitative Evaluation

Abstract

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.

Telehealth effectiveness for pre‐exposure prophylaxis delivery in Brazilian public services: the Combine! Study

“…One frequent concern regarding telehealth is the possibility of negatively affecting adherence to PrEP or STI diagnoses. Our results indicate another direction, consolidating the evidence [9, 12, 15] that telehealth allows the maintenance of a standard of care equivalent to in‐person care. This may have resulted from the study protocol, which offered telehealth to those on PrEP for a minimum period.…”

“…Telehealth has emerged as a promising strategy for minimizing difficulties related to aspects of service organization, clinical follow‐up requirements and the vulnerability of HIV‐affected populations [ 6 , 7 , 8 ] by allowing users more significant rationalization of services and autonomy [ 9 , 10 , 11 , 12 , 13 , 14 ]. The feasibility [ 13 , 15 ] and acceptance [ 10 , 11 , 16 , 17 ] of PrEP delivery through telehealth are higher in high‐income countries but unknown in middle‐ and low‐income countries [ 18 ]. Robust evaluations of telehealth are thus necessary to increase evidence of the effectiveness of PrEP, including adherence and persistence, with more incredible benefits for settings where access and use are challenging.…”

“…Telehealth is also associated with greater diversification of the population profile on PrEP [ 12 ], more excellent geographic coverage [ 9 ] and an increase in the number of higher‐risk people on PrEP [ 16 ]. Additionally, telehealth for screening and follow‐up increases PrEP uptake [ 15 ] and persistence [ 9 , 12 ]. However, most studies included small sample sizes and lacked comparison groups, making it challenging to understand whether these results were due to telehealth.…”

Effectiveness of PrEPTECH: Findings From a 180-Day Randomized Controlled Trial of a Pre-Exposure Prophylaxis Telehealth Intervention

“…12 Preliminary evidence from research on these early efforts suggests that PrEP telehealth is well received, often preferred to traditional models, and has been effective in delivering PrEP care to its clients. 13–29 There have been relatively few reports in the literature on PrEP telehealth outside the United States, but efforts have been described in Brazil, Vietnam, Thailand, Germany, and Kenya. 27,30,31…”

Financing and Delivering Pre-Exposure Prophylaxis (PrEP) to End the HIV Epidemic

“…60 Evidence is emerging that telehealth programs offer tremendous advantages for PrEP access and may be able to bridge some of these gaps in community settings. 61 Telehealth programs for PrEP are increasing across the country, driven in part by adaptations of HIV services in response to the COVID-19 pandemic. 62 Some programs, such as Iowa's, have established a "telePrEP" program through a partnership between the state's health department and an academic medical center.…”