Integrating PrEP into STD Partner Services in Washington State

Transcription

1 Integrating PrEP into STD Partner Services in Washington State David Katz, PhD MPH University of Washington Public Health Seattle & King County NCSD Engage November 16, 2017

2 STD Partner Services (PS) in Washington State STD PS present an opportunity to provide population-based HIV prevention to people at high risk In 2012, WA State began integrating interventions across HIV prevention/care oddslot continuum - PrEP referral - HIV testing - HIV/STI testing reminders - Engagement in HIV care Simultaneously prioritized MSM for PS - MSM account for >2/3 of HIV infections in WA - Facilitated by gender of sex partners on case report

3 King County PS Program & PrEP Referrals DIS attempt to provide partner services to MSM w/ STIs DIS assess HIV status & PrEP eligibility HIV-negative MSM at high risk 1 early syphilis or rectal GC methamphetamine or poppers use sex work HIV-unsuppressed partner Black or Latino HIV-negative MSM at lower risk CT or urethral/pharyngeal GC without behavioral risk Offer referral to PrEP at public health STD clinic or community providers Offer referral to community providers for PrEP 1 ents/hiv/prep-implementation-guidelines.ashx

4 King County STD Clinic PrEP Program Focus on MSM at high risk (risk-prioritized) and Black & Latino MSM (to address inequities in access) PrEP fully integrated all clinicians can prescribe DIS coordinate the program - Counseling, payment assistance applications, HIV/STD screening - SMS-based appointment reminder and two-way text system Baseline visit same day PrEP prescription Follow-up visits every 3 mo. with DIS Clinicians only see patients at intake, then every 6 months

5 Evolution of PrEP Referral Process Practice Evidence Oct 2014 Assess & refer ES to PrEP ES highest risk of concurrent STI/HIV dx 1 May 2015 Assess all, Refer ES & rectal GC Rectal GC highest risk of future HIV 2 Jan 2016 Refer all, Stratified by risk Post-STI HIV incidence 2 DOH/PHSKC Guidelines 3 Apr 2017 Black & Latino MSM eligible for PH PrEP 4 Nov 2017 Black/Latino <PrEP than white MSM 4 Improve process for trans/nonbinary clients 1 Katz et al. AIDS Patient Care STDs 2016; 30: Katz et al. Sex Transm Dis 2016; 43: Implementation-Guidelines.ashx. 4 Katz et al. CROI 2017, Abstract 89.

6 Supplemental Database PrEP Questions

7 PS Delivery & PrEP Use 7546 STI cases reported among HIV-negative MSM Aug 2014 Aug (50%) received partner services 2055 (55%) at high risk for HIV early syphilis or rectal GC 538 other risk 1684 (45%) at lower risk for HIV 1840 (90%) had PrEP use assessed 1398 (83%) had PrEP use assessed 907 (49%) on PrEP already 951 (51%) not on PrEP 443 (31%) on PrEP already 976 (69%) not on PrEP 1 Does not include Black/Latino MSM with no other risk; criterion added April 2017

8 PrEP Referral Outcomes 100% 80% 60% 40% Among 539 high risk MSM with STDs who reported not being on PrEP during PS interview, Jan 2016-Aug % 86% Of offered, 18% known to have attended visit* Unable to assess external referrals 20% 0% Interviewed, Not on PrEP Offered PrEP referral 49% 56% 41% Accepted PrEP referral 80% 20% 16% Accepted PH clinic referral Attended PrEP assessment visit* Cases *Within 3 months of PS interview

9 Prospective Assessment Objectives - Assess effectiveness of referrals - Inform decision re: additional follow-up post-referral Methods - Random sample of MSM not on PrEP from 2016 PS - Stratified by high/low risk and did/did not accept referral - 3-minute follow-up phone interview to: Assess PrEP use following PS Identify barriers to PrEP/reasons for stopping Determine current interest/eligibility and offer new referrals Current status - DIS completed interviews Apr-Sep Analyses to inform follow-up activities underway

10 Facilitators and Barriers Facilitators Gender of sex partners on case report Dedicated DIS Existing supplemental database PH PrEP clinic Availability of PrEP in community State drug assistance program Barriers Recorded in separate database Balancing standard PS activities vs PrEP Navigating insurance, assistance program

11 Other Models in WA State Pierce Co. DIS refer to 1 provider group Appointing privileges EMR access ROI to share records PH offers quarterly labs DIS follow up with patients who do not schedule or attend appointments Spokane DIS refer to PH navigators for persons at high risk for HIV (PAHR) PrEP education, referral, & adherence support Insurance & care linkage Other social/medical needs Refer to and support community providers

12 Summary & Conclusions STD PS present an opportunity to promote PrEP to a large and diverse population of MSM at high risk for HIV LHJs developed unique approaches to PrEP promotion based on their context and resources King County - Referring MSM to a PH clinic and community providers was successful at promoting PrEP - Additional efforts needed to improve delivery and uptake at each step of referral process - Ongoing M&E used to improve prioritization and process PrEP promotion should be considered an outcome of STD PS for high risk populations

13 Acknowledgments AAPPS Evaluation Team - Teal Bell, Matt Golden, Julie Dombrowski, Zandt Bryan Local Health Jurisdictions - Field services teams - King: Dawn Spellman, Mike Barry, Christina Thibault, PrEP clinic team - Spokane: Lisa St. John - Pierce: Evelyn Manley Rodriguez, LaShawn Jones CDC DSTDP - Brandy Maddox, Marion Carter Funding & Support - CDC AAPPS Evaluation Supplement & Minority AIDS Initiative - Washington State DOH - Public Health Seattle & King County