Background: With 50,000 new infections each year in the US there is an urgent need to incorporate new strategies for prevention, especially in key populations such as MSM, transgender women and Black/African American communities. The approval of Truvada (TDF/FTC) for Pre-Exposure Prophylaxis (PrEP) by the US FDA in 2012 invigorated prevention efforts. Uptake has been slow as facilities struggle to address community awareness, staff training, access, visit costs and ensuring quality of care delivered.
Description: Callen-Lorde Community Health Center (CLCHC) is an LGBT-focused center in NYC. PrEP was initiated in a pilot phase in 2012 and scaled up as a discrete program in 2015. CLCHC''s program focus is on connecting key populations (MSM, Transgender people and people of color) to PrEP. The initial demand for services was overwhelming and threatened to overload clinic capacity. Challenges included providers'' unwillingness to prescribe, lack of provider knowledge, navigating complex insurance and medication assistance programs, clinical workflow, time constraints, protocol development, data collection, ensuring cultural competency and maintaining a sex-positive environment, free of PrEP-stigma. Several operational meetings were convened with internal and external stakeholders to design a centralized program that ensured consistent and quality care.
Lessons learned: A clinical workflow was established to minimize the clinicians'' role and maximize the role of non-clinical staff, e.g., patient navigators & HIV counselors. Templates and electronic flags were implemented to document PrEP consultations, order specific labs and track patients using an innovative prescription algorithm. The implementation of self-collected STD specimens reduced the burden on clinical staff. The clinic designed videos (available on YouTube) to address common questions about PrEP. PrEP Specialists were hired to carry out all administrative functions, troubleshoot medication access and assist with counseling on adverse effects and monitoring adherence.
Conclusions/Next steps: Once aware, there is demand from the LGBT community for PrEP. Multi-disciplinary teams of clinicians, social workers, nurses and HIV counselors must collaborate in order to support patients throughout the PrEP care continuum. Agencies must allow flexibility and innovation to take place when developing PrEP protocols and programs.

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