Implementation of HIV Preexposure Prophylaxis in a Homeless Primary Care Setting at the Veterans Affairs

GREGG, ELIZABETH; Linn, Carrie; Nace, Emma; Gelberg, Lillian; Cowan, Brianna; Fulcher, Jennifer A.

doi:10.1177/2150132720908370

Cited by 14 publications

(10 citation statements)

References 20 publications

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“…As such, initiatives to enhance primary care attachment and address housing insecurity for PWID after hospitalization should be explored. Access to low-barrier HIV services and treatment, as well as pre-exposure prophylaxis in the prevention of HIV, are important considerations for this subgroup of PWID [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Infectious diseases, comorbidities and outcomes in hospitalized people who inject drugs (PWID)

et al. 2022

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Injection drug use poses a public health challenge. Clinical experience indicates that people who inject drugs (PWID) are hospitalized frequently for infectious diseases, but little is known about outcomes when admitted. Charts were identified from local hospitals between 2013–2018 using consultation lists and hospital record searches. Included individuals injected drugs in the past six months and presented with infection. Charts were accessed using the hospital information system, undergoing primary and secondary reviews using Research Electronic Data Capture (REDCap). The Wilcoxon rank-sum test was used for comparisons between outcome categories. Categorical data were summarized as count and frequency, and compared using Fisher’s exact test. Of 240 individuals, 33% were admitted to the intensive care unit, 36% underwent surgery, 12% left against medical advice (AMA), and 9% died. Infectious diagnoses included bacteremia (31%), abscess (29%), endocarditis (29%), cellulitis (20%), sepsis (10%), osteomyelitis (9%), septic arthritis (8%), pneumonia (7%), discitis (2%), meningitis/encephalitis (2%), or other (7%). Sixty-six percent had stable housing and 60% had a family physician. Fifty-four percent of patient-initiated discharges were seen in the emergency department within 30 days and 29% were readmitted. PWID are at risk for infections. Understanding their healthcare trajectory is essential to improve their care.

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Section: Discussionmentioning

confidence: 99%

Infectious diseases, comorbidities and outcomes in hospitalized people who inject drugs (PWID)

et al. 2022

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“…Gregg et al highlighted obstacles to initiating PrEP, including inadequate screening and the presence of inconsistencies in the workflow process to initiate PrEP in the Veterans Affairs (VA) system [ 20 ]. In order to implement a successful PrEP program, Gregg et al explored the main obstacles to accessing PrEP and presented a model for integrating PrEP as part of a primary care clinic for homeless veterans [ 20 ]. The study created an institutional prescription protocol for primary care providers and clinical pharmacists to provide and initiate PrEP for patients [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

“…In order to implement a successful PrEP program, Gregg et al explored the main obstacles to accessing PrEP and presented a model for integrating PrEP as part of a primary care clinic for homeless veterans [ 20 ]. The study created an institutional prescription protocol for primary care providers and clinical pharmacists to provide and initiate PrEP for patients [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

A Qualitative Systematic Literature Review of the Role of U.S. Pharmacists in Prescribing Pre-Exposure Prophylaxis (PrEP)

et al. 2023

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Pre-Exposure Prophylaxis (PrEP) is an effective treatment to combat the human immunodeficiency virus (HIV) endemic, but the uptake of PrEP has been low in the United States (U.S.). While individuals may access PrEP via obtaining a prescription from their prescriber and having it dispensed by their pharmacist, less cumbersome access points may exist. This systematic literature review evaluates qualitative literature to explore the role of pharmacists, pharmacy services, and interprofessional collaborations for persons seeking PrEP in the United States. Four electronic databases (PubMed, Scopus, CINAHL, and Embase) were searched in February 2022 and yielded 3841 results. After excluding duplicates, two researchers reviewed 2461 studies. These results were screened for inclusion and exclusion criteria and yielded 71 studies for full review. Out of these 71 studies, five studies met the pre-selected inclusion criteria. Of the five studies, four were qualitative studies, and one was a mixed-methods study. The studies examined different aspects of initiating PrEP and diverse outcomes, such as screening for PrEP, barriers to access PrEP, feasibility to access PrEP, accessibility via community pharmacy to PrEP, and interdisciplinary collaboration between members of the healthcare team to expand patient access to PrEP. A gap in the qualitative literature focusing on U.S. pharmacists’ roles in initiation and provision of PrEP for diverse populations may exist. While PrEP promotion and uptake are largely affected by convenience and accessibility, future interventions and strategies should include training pertaining to PrEP screening, stigma reduction, privacy considerations, and PrEP dispensing.

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“…This finding is supported by the literature, which shows that PrEP knowledge among persons experiencing homelessness is extremely low, especially in the U.S. South. To our knowledge, there are just two published studies on providing PrEP services to persons experiencing homelessness ( Biello et al, 2021 ; Gregg et al, 2020 ). Thus, future iterations of AH3 will also focus on expanding PrEP care to persons experiencing homelessness.…”

Section: Implications For Practicementioning

confidence: 99%

Addressing HIV and Homelessness During COVID-19: A Community-Based Demonstration Project

Kay

Bruce

Foster-Hill

et al. 2022

Health Promotion Practice

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People experiencing homelessness are at increased risk for HIV, and people with HIV (PWH) experiencing homelessness are more likely to experience suboptimal HIV health outcomes than PWH with stable housing. Within Alabama, a state prioritized in the Ending the HIV Epidemic initiative, Jefferson County consistently has the highest number of new HIV diagnoses as well as a high percentage of the state’s homeless population. To address the twin epidemics of both HIV and homelessness within the high-priority setting of Jefferson County, Alabama, this 1-year community-based project, Ending the HIV Epidemic: Addressing HIV Health and Homelessness (AH3), sought to increase HIV testing and linkage to care among this population by placing a full-time case manager trained in HIV testing and case management at a homeless shelter. Results demonstrated that HIV testing was highly acceptable: 733 individuals were offered a test, and only 2.7% (n = 20) declined. Nine previously diagnosed, out of care PWH and one newly diagnosed PWH were identified through AH3 testing efforts. Of these, five (50%) were linked to care at a local HIV clinic. The remaining five PWH left the shelter before they could be linked to care. Just 10 shelter guests expressed interest in taking PrEP (just 1.4% of guests who tested negative for HIV), and only one of these linked to PrEP care. Future health promotion programs are needed to address mental health and other ancillary needs among this population, as well as programs that provide access to PrEP and other HIV prevention services.

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Implementation of HIV Preexposure Prophylaxis in a Homeless Primary Care Setting at the Veterans Affairs

Cited by 14 publications

References 20 publications

Infectious diseases, comorbidities and outcomes in hospitalized people who inject drugs (PWID)

Infectious diseases, comorbidities and outcomes in hospitalized people who inject drugs (PWID)

A Qualitative Systematic Literature Review of the Role of U.S. Pharmacists in Prescribing Pre-Exposure Prophylaxis (PrEP)

Addressing HIV and Homelessness During COVID-19: A Community-Based Demonstration Project

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