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

Abstract

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.

A Demedicalized Model to Provide PrEP in a Sexual Health Clinic

“…Stephanie Cohen and Oliver Bacon). In Chicago and New Orleans, despite warm handoffs via PrEP navigators or public health staff to an external PrEP provider, only 31% and 43% of referred patients attending an initial PrEP visit attended a subsequent PrEP visit 34,35 ; this high level of discontinuation occurred even when the PrEP clinic was separate but colocated with the SHC in New Orleans. Our experience suggests that rapid PrEP initiation provided as part of routine SHC visits and flexible demedicalized follow-up may help to engage and retain patients on PrEP.…”

The need for sexual health clinics, their future role, and contribution to public health

“…This would also include studies related to health services and implementation science, which greatly contribute to the application and understanding of STI and HIV prevention management in real world settings. [51][52][53][54][55] Sentinel surveillance for STIs and HIV is a critical public health function incorporated into many SHCs. Sentinel surveillance involves the ongoing and systematic collection of case data from a sample of providers (in this case, SHCs) to identify trends in STIs in the larger population.…”

Behavioral and social interventions to promote optimal HIV prevention and care continua outcomes in the United States

“…Peer navigation has the potential to bridge these gaps in testing and treatment by increasing timely linkage to care. Lillis et al [63] demonstrated short-term increases in PrEP appointments in a sexual health clinic when a peer navigator was available for a warm handoff compared to those who received a referral from a provider or an E-Mail from peer navigators. Sevelius et al [64 ▪ ] developed and implemented a sex-affirming PrEP program for transgender adults at two healthcare centers, demonstrating the potential of co-locating peer navigation and gender affirming care in existing healthcare settings.…”

“…Four studies published within this past year evaluated interventions premised on co-locating services to enhance uptake and use of HIV prevention and treatment technologies [62,63,64 ▪ ,65]. Lipps et al [62] integrated infectious disease specialists within emergency departments to increase HIV and STI testing and treatment and to provide additional training, resources, and timely support to medical providers.…”

“…Across interventions, peer navigators have different roles, training, organizational support, and connections to the communities they serve. Additionally, peer navigators may be unable to provide consistent, uniform support to clients as scheduling constraints and ability to adequately address clients other needs (e.g., substance use, violence) may vary [63,64 ▪ ].…”