Original Models of HIV Pre-Exposure Prophylaxis Care Used in Title X Family Planning Clinics in the Southern US

• Type of Material: Article
• Authors: Kaitlin N Piper, Emory University; Ngoc-Cam Escoffery, Emory University; Jessica Sales, Emory University; Anandi Sheth, Emory University
• Language: English
• Date: 2021-02-17
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Society for Adolescent Health and Medicine. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jadohealth.2020.10.005
• Title of Journal or Parent Work: JOURNAL OF ADOLESCENT HEALTH
• Volume: 68
• Issue: 3
• Start Page: 480
• End Page: 487
• Grant/Funding Information: This research was supported by the National Institutes of Health grant U24HD089880. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health; J. Sales and A. Sheth received grant funding from Gilead Sciences, Inc, to Emory University for unrelated work.; This work was also presented at the Society for Adolescent Health and Medicine (2020).
• Keywords: Psychology; Psychology, Developmental; HIV/AIDS; Pediatrics; PrEP; Social Sciences; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; Adolescents; Implementation; Science & Technology; Family planning

Abstract

Purpose: HIV pre-exposure prophylaxis (PrEP) is underutilized by adolescent and young adult women, especially in the Southern U.S. Family planning (FP) clinics are potentially ideal PrEP delivery sites for adolescent and young adult women, but little is known about their PrEP services. We describe models of PrEP care in Title X FP clinics in the South and explore clinic resources that are needed to facilitate PrEP provision. Methods: Providers and administrators from 38 clinics participated in qualitative interviews. We assessed five steps of PrEP care: (1) HIV risk assessment; (2) PrEP education; (3) laboratory testing; (4) PrEP prescription; and (5) PrEP monitoring. Results: Among 38 clinics, 23 conducted at least one step and were classified into three models. Model 1 (n = 8) and Model 2 (n = 4) clinics provided up to Steps 1 and 2, respectively, but referred to an external PrEP provider. Model 3 clinics (n = 11) conducted all steps. Few barriers were identified for Step 1; using an HIV risk assessment tool was a key facilitator. PrEP educational materials facilitated Step 2; clinics not providing education believed they could easily do so with training and educational resources. Funding- and staff-related resource barriers were noted for Steps 3–5, including costs of laboratory tests and lack of time for longitudinal visits. Conclusions: PrEP-providing publicly funded FP clinics in the Southern U.S. use referral services for many steps of PrEP care, which introduce patient burden. Increasing onsite PrEP services will require addressing concerns related to training, educational materials, cost, and staffing.