A De-medicalized Model to Provide PrEP in a Sexual Health Clinic

• Published in: Journal of acquired immune deficiency syndromes (1999)
• Main Authors: Ramchandani, Meena S, Berzkalns, Anna, Cannon, Chase A, Dombrowski, Julia C, Ocbamichael, Negusse, Khosropour, Christine M, Barbee, Lindley A, Golden, Matthew R
• Format: Journal Article
• Language: English
• Published: United States 15.08.2022
• ISSN: 1944-7884
• DOI: 10.1097/QAI.0000000000003005

Sexual Health Clinics (SHCs) serve large numbers of patients who might benefit from PrEP. Integrating longitudinal PrEP care into SHCs can overburden clinics. We implemented a SHC PrEP program that task shifted most PrEP operations to non-medical staff, disease intervention specialists (DIS). We conducted a retrospective cohort analysis of PrEP patients in a SHC in Seattle, WA, USA 2014-2020 to assess the number of patients served and factors associated with PrEP discontinuation. Clinicians provide same-day PrEP prescriptions while DIS coordinate the program, act as navigators, and provide most follow-up care. Between 2014 and 2019, 1,387 patients attended an initial PrEP visit, 93% of whom were men who have sex with men. The number of patients initiating PrEP per quarter year increased from 20 to 81. The number of PrEP starts doubled when the clinic shifted from PrEP initiation at scheduled visits to initiation integrated into routine walk-in visits. The percentage of visits performed by DIS increased from 3% in 2014 to 45% in 2019. Median duration on PrEP use was 11 months. PrEP discontinuation was associated with non-Hispanic Black race/ethnicity (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.02-1.76), age <20 years (HR 2.17, 95% CI 1.26-3.75), age 20-29 (HR 1.55, 95% CI 1.06-2.28), and methamphetamine use (HR 1.98, 95% CI 1.57-2.49). The clinic had 750 patients on PrEP in the final quarter of 2019. A de-medicalized SHC PrEP model that task shifts most operations to DIS can provide PrEP at scale to high priority populations.