Background: The US Food and Drug Administration approved Pre-Exposure Prophylaxis (PrEP) for HIV prevention in July 2012. As demand for PrEP increased in San Francisco, barriers to access surfaced: lack of provider knowledge of PrEP, finding a culturally competent provider, issuance of same-day prescriptions, and coverage of laboratory and medication costs. San Francisco AIDS Foundation (SFAF) launched a PrEP program in 2014 to address barriers, increase access, and reduce new HIV infections among MSM.
Description: The program, led by Nurse Practitioners, leverages Registered Nurses and volunteer HIV test counselors (HTC) trained to provide culturally competent care. Clients self-refer or are referred by HTC. NPs perform a full medical evaluation and PrEP counseling, addressing adherence and stigma. Utilizing point-of-care HIV and chemistry testing, clients initiate PrEP the same-day. Follow-up visits are conducted by RNs, providing ongoing PrEP and adherence counseling. Abnormal lab results are referred to the NP for evaluation. MDs are available for consultation as needed.
Benefits Navigators work with medically eligible clients to access PrEP through applying for full-assistance programs, activating copay cards, and initiating health insurance. Navigators interface with insurance companies when clients are met with barriers. There is no cost for the lab work and evaluation services. With the available benefit programs, most clients obtain PrEP at no or very low cost.
Lessons learned: Between November 2014 and January 2016, 797 participants enrolled in the program and 95% received a prescription for Truvada. 89% reported condomless anal sex in the past 12-months. 69% were Caucasian, 22% Latino/Hispanic, 6% African-American, and 11% Asian/Pacific Islander. Mean age was 34.4 years. 25% were treated for an STI at enrollment.
There were no new HIV infections among participants in the PrEP program. Comparatively, the clinic diagnosed 54 new HIV infections among men not enrolled in the program during the same time period.
Conclusions/Next steps: A community-based organization, led by NPs, RNs, benefits navigators, and HTCs can determine if clients are medically eligible to begin PrEP, assist with identifying and addressing barriers to accessing PrEP so clients can safely initiate medication the same-day, contributing to fewer HIV diagnoses among MSM in San Francisco.