Women and PrEP: What are local health departments doing? Gretchen Weiss, MPH Director of HIV, STI, & Viral Hepatitis National Association of County and City Health Officials (NACCHO) Illinois HIV/STD Conference Wednesday, October 28, 2015
Public Health and PrEP Local public health (PH) serves an ideal role as a connector between many parts of a broader network. Providers Epidemiologic and effectiveness research PH At-risk persons/subgroups/ populations Prevention and screening programs
Public Health Core Functions and 10 Essential Services Source of Ten Essential Public Health Services: Core Public Health Functions Steering Committee, 1994; http://www.cdc.gov/nphpsp/essentialservices.html
PrEP Delivery Cascade Community/Patient 1. At risk for HIV infection 2. Identified as PrEP candidate Provider 1. Providing healthcare to high-risk populations 2. Educated about PrEP 3. Interested in PrEP 3. Willing to provide PrEP 4. Linked to PrEP program 5. Initiated PrEP 6. Retained in PrEP program Liu A, et al. IAPAC 2012; Miami. #80040 U.S. Centers for Disease Control and Prevention SHIPP Study 2013-2016 7. Achieve and maintain medication adherence
Theoretical model of the PrEP care continuum, factors relevant to uptake, and areas for intervention. Colleen F. Kelley et al. Clin Infect Dis. 2015;61:1590-1597 The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
PrEP Care Cascade Source: http://www.aidsmap.com/us-prep-care-cascade-analysis-suggests-that-major-structural-barriers-needto-be-addressed-for-prep-to-have-an-impact/page/2997511/
What LHDs Can Do Identify who might benefit from PrEP at a population and individual level Identify healthcare providers willing to prescribe PrEP Develop resource inventories and serve as local experts Convene or participate in a local or state working group on PrEP Conduct education and outreach to at-risk community members, healthcare providers, HIV prevention partners, and LHD staff Refer at-risk individuals to PrEP providers/programs Collaborate with healthcare providers to support PrEP delivery Deliver/prescribe PrEP via a health department clinic Conduct PrEP navigation, including financial case management Fund CBOs and other agencies to support PrEP implementation Monitor and evaluate PrEP uptake and impact
What LHDs Can Do Identify who might benefit from PrEP at a population and individual level Identify healthcare providers willing to prescribe PrEP Develop resource inventories and serve as local experts Convene or participate in a local or state working group on PrEP Conduct education and outreach to at-risk community members, healthcare providers, HIV prevention partners, and LHD staff Refer at-risk individuals to PrEP providers/programs Collaborate with healthcare providers to support PrEP delivery Deliver/prescribe PrEP via a health department clinic Conduct PrEP navigation, including financial case management Fund CBOs and other agencies to support PrEP implementation Monitor and evaluate PrEP uptake and impact
LHD Examples Chicago Department of Public Health (CDPH) o Active referral from all five CDPH STI clinics o Partner sites: Howard Brown Health Center, University of Chicago, Mount Sinai o Referral for high-risk groups including MSM and transgender and cisgender women with a rectal STI or syphilis; commercial sex workers; IDU; and persons with an HIV positive sexual partner o Working to establish on-site PrEP navigation Champaign-Urbana Public Health District o Originally planned to conduct education and outreach, increase provider capacity, and link interested individuals to providers o However, decided to prescribe PrEP in the STD clinic to better meet client needs and overcome barriers to access o Approximately 20 clients currently receiving PrEP
LHD Examples Denver Public Health o Internal referral from the STD clinic to the HIV care clinic o Key steps in program development included assessing who might benefit from PrEP, identifying willing clinicians, engaging with linkage to care and prevention counseling staff, developing a protocol, and creating informational and marketing materials Hennepin County Public Health Clinic Red Door Services o Added PrEP to existing HIV prevention services o Supported by MSM-focused funding from the Minnesota Department of Health; PrEP program administered through the Health Interventions for Men (HIM) program o Approximately 250 clients currently on PrEP, of which approximately 15 are transgender women o Cisgender women are referred from Red Door Services to other providers in the community
LHD Examples New York City Department of Health and Mental Hygiene o Prep for PrEP conducted a programmatic needs assessment at STD clinics o Developed a program that combines a public awareness campaign; outreach and support to medical clinics, including public health detailing; expanded access to PrEP and PEP; and monitoring PrEP and PEP uptake
Facilitating Access to PrEP for Women Increase the number of providers knowledgeable about PrEP, especially among those serving at-risk/high-risk women; targeted provider outreach Increase awareness and knowledge of PrEP among women; locally-informed strategies for reaching women at risk Increase discussion of women and PrEP internally and with partners, such as through HIV prevention planning councils More research is needed LHDs have a unique understanding of the local epidemiologic profile for HIV and other influencers within the community; this information is critical for facilitating access to PrEP for women
Thank You Learn more at www.naccho.org/hivprep Contact Information: Gretchen Weiss, MPH Director of HIV, STI, & Viral Hepatitis gweiss@naccho.org 202-507-4276