Project SLIP: Implementation of a PrEP Screening and Linkage Intervention in Primary Care

Storholm, Erik D.; Siconolfi, Daniel; Huang, Wenjing; Towner, William; Grant, Donald C.; Martos, Alexander; Chang, John; Hechter, Rulin C.

doi:10.1007/s10461-021-03197-w

Cited by 10 publications

(9 citation statements)

References 33 publications

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“…This suggests that an intervention might focus on promoting routine screening to aid in the rapid and routine identification of patients who may be at risk for HIV but who do not reside in commonly known risk groups. Preliminary evidence suggests that routine screening in primary care can aid in the rapid identification of potential PrEP candidates that may otherwise be missed (Storholm et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Primary Care Providers’ Knowledge, Attitudes, and Beliefs About HIV Pre-Exposure Prophylaxis (PrEP): Informing Network-Based Interventions

Storholm

Ober

Mizel

et al. 2021

AIDS Education and Prevention

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Increasing access to pre-exposure prophylaxis (PrEP) in primary care settings for patients who may be at risk for HIV could help to increase PrEP uptake, which has remained low among certain key risk populations. The current study conducted interviews with primary care providers identified from national claims data as having either high or low likelihood of serving PrEP-eligible patients based on their prescribing practices for other sexually transmitted infections. The study yielded important information about primary care providers’ knowledge, attitudes, and beliefs about PrEP, as well as the barriers and facilitators to prescribing PrEP. Key recommendations for a provider-focused intervention to increase PrEP prescribing among primary care providers, including increasing patient education to increase demand from providers, enhancing provider education, leveraging technology, and instituting standardized sexual health checks, are provided with the goal of informing network-based interventions.

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Section: Discussionmentioning

confidence: 99%

Primary Care Providers’ Knowledge, Attitudes, and Beliefs About HIV Pre-Exposure Prophylaxis (PrEP): Informing Network-Based Interventions

Storholm

Ober

Mizel

et al. 2021

AIDS Education and Prevention

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“…72−74 For example, PrEP screening in a primary care system in Southern California resulted in a significant increase in PrEP referrals, compared with that in the previous year. 32 Other programs, such as the San Francisco Magnet Clinic, leverage the opportunity to provide PrEP to those already seeking STI treatment and other sexual health services. 75 Notably, most participants remaining in care in the U.S. PrEP Demonstration Project (2012−2015), which provided PrEP in 2 STI clinics and 1 community health center, achieved adherence consistent with ≥4 doses per week at 48 weeks according to TFV-DP levels in DBS.…”

Section: Ymsm and Ytgwmentioning

confidence: 99%

Pre-exposure Prophylaxis Uptake, Adherence, and Persistence: A Narrative Review of Interventions in the U.S.

Garrison

Haberer

2021

American Journal of Preventive Medicine

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Since 2012, HIV pre-exposure prophylaxis (PrEP) has been available to prevent HIV transmission; yet, uptake, adherence, and persistence to PrEP have been suboptimal. This narrative review examines the latest interventions and programs to improve all 3 stages of PrEP adherence and reviews ongoing studies to promote effective PrEP use. From 2017 to 2020, a total of 20 studies analyzed different individual-and structural-level approaches to increase PrEP adherence, including behavior change interventions, technology-based interventions (e.g., short message service messages and mobile applications), and alternate delivery strategies (e.g., pharmacy-based PrEP, integration with other services, and home delivery). Most published interventions involved men who have sex with men, although 3 assessed women (2 transgender, 1 cisgender). Randomized, controlled data support 3 behavioral change interventions and 1 technology-based intervention. Alternate delivery strategies seem promising, although more robust study designs are generally needed. In addition, data on the alignment of ongoing HIV risk and PrEP persistence (i.e., prevention-effective adherence) were limited. The authors also identified 20 ongoing studies that are promoting PrEP adherence. Future work should be inclusive of all at-risk groups in the U.S., including African American and Latinx heterosexual populations and people who inject drugs. Proven and promising approaches may work well in combination and may also need to be adapted with the introduction of long-acting pre-exposure prophylaxis formulations. Collectively, this body of work indicates considerable progress toward understanding the role PrEP adherence will play in Ending the HIV Epidemic in the U.S. that will be bolstered by the outcomes of ongoing trials.

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“…22 The detail in a prior publication. 22 Briefly, a 6-item sexual risk screening instrument for facilitating PrEP uptake was developed and integrated into the workflow of two primary care clinics contained within a large, integrated health system, Kaiser Permanente Southern California (KPSC), as part of Project SLIP. At KPSC, PrEP is primarily provided with HIV specialty care services.…”

Section: Intervention Overviewmentioning

confidence: 99%

“…At KPSC, PrEP is primarily provided with HIV specialty care services. 22 Kaiser Permanente provides care for over 9 million Californians. 23 Providing screening and linkage to PrEP from Kaiser's primary care clinics could greatly extend PrEP services to many members of communities at risk for HIV.…”

Section: Intervention Overviewmentioning

confidence: 99%

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Barriers and Opportunities to Improve the Implementation of Patient Screening and Linkage to Pre-Exposure Prophylaxis in Primary Care

Nacht

Muthuramalingam

Storholm

et al. 2022

JCRHAP

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Although pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV infection, only around 25% of at-risk individuals in the United States have accessed a prescription. One way to increase PrEP uptake is through the sexual health screening of patients and linkage to PrEP in primary care settings. The objective of this analysis was to assess the barriers and implementation strategies during a screening and linkage to PrEP pilot intervention. Primary care patients were screened for PrEP indication during routine primary care visits. Of the 1,225 individuals screened, 1.8% (n=22) were eligible for PrEP and from those, 77.3% (n=17) attended the specialist appointment and were prescribed PrEP. Primary care patients (n=30) and providers (n=8) then participated in semi-structured interviews assessing their experience with the pilot intervention. Using an applied thematic analytic approach, patients and providers identified barriers and related improvement strategies that could be classified into four main categories: 1) Financial Barriers: Individual- vs. Clinic-level Considerations 2) The Role of Stigma, Discomfort, and Cultural Factors 3) Logistical Hurdles and Streamlining the Intervention, and 4) The Lack of PrEP Knowledge and the Need for Education. Findings support the accepatability and feasibility of screening for PrEP in primary care along with appropriate implementation strategies. This study suggests that because of the high volume of patients seen in primary care, sexual health screenings and linkage to PrEP interventions have the potential to reduce new incident HIV infections among diverse sexual minority men.

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Project SLIP: Implementation of a PrEP Screening and Linkage Intervention in Primary Care

Cited by 10 publications

References 33 publications

Primary Care Providers’ Knowledge, Attitudes, and Beliefs About HIV Pre-Exposure Prophylaxis (PrEP): Informing Network-Based Interventions

Primary Care Providers’ Knowledge, Attitudes, and Beliefs About HIV Pre-Exposure Prophylaxis (PrEP): Informing Network-Based Interventions

Pre-exposure Prophylaxis Uptake, Adherence, and Persistence: A Narrative Review of Interventions in the U.S.

Barriers and Opportunities to Improve the Implementation of Patient Screening and Linkage to Pre-Exposure Prophylaxis in Primary Care

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