A De-medicalized Model to Provide PrEP in a Sexual Health Clinic : JAIDS Journal of Acquired Immune Deficiency Syndromes

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Implementation Science

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

Ramchandani, Meena S. MD, MPH1,3; Berzkalns, Anna MPH3; Cannon, Chase A. MD, MPH1; Dombrowski, Julia C. MD, MPH1,2,3; Ocbamichael, Negusse PA-C3; Khosropour, Christine M. PhD, MPH2; Barbee, Lindley A. MD, MPH1,3; Golden, Matthew R. MD, MPH1,2,3

Author Information

1Department of Medicine, University of Washington, Seattle, Washington, USA.

2Department of Epidemiology, University of Washington, Seattle, Washington, USA.

3HIV/STD Program, Public Health-Seattle & King County, Seattle, Washington, USA.

Corresponding Author: Meena Ramchandani, MD, MPH Division of AID, University of Washington 325 9th Ave, Mailstop 359777 Harborview Medical Center Seattle, WA. 98104, USA

Conflicts of Interest and source of funding: JCD, LAB, CMK and MRG have received research support, unrelated to this work, from Hologic. LAB has received research support outside of this work from SpeeDx and Nabriva and received consulting fees from Nabriva. MRG received research support unrelated to this work from GlaxoSmithKline. MSR owns stock in Gilead and Merck. For the remaining authors, none were declared.

Funding: Research reported in this publication was supported by NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA, NIGMS, NIDDK of the National Institutes of Health under award number AI027757

JAIDS Journal of Acquired Immune Deficiency Syndromes ():10.1097/QAI.0000000000003005, April 29, 2022. | DOI: 10.1097/QAI.0000000000003005

Abstract

Background: 

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).

Methods: 

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.

Results: 

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.

Conclusions: 

A de-medicalized SHC PrEP model that task shifts most operations to DIS can provide PrEP at scale to high priority populations.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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