PrEP and Local Health Departments: Building the Infrastructure Gretchen Weiss, MPH Director of HIV, STI, & Viral Hepatitis National Association of County and City Health Officials (NACCHO) 2015 National HIV Prevention Conference Tuesday, December 8, 2015
Background Communities are at varying stages of PrEP awareness and implementation Achieving the full promise of PrEP will require coordination among many groups, including local and state health departments, healthcare providers, community-based organizations, community members, and the federal government Need to build and configure the infrastructure and systems for PrEP delivery To help build this infrastructure, NACCHO is working to increase local health department (LHD) awareness and knowledge of PrEP, highlight and inform the LHD role in PrEP implementation, and increase LHD capacity to fulfill this role To inform these efforts, NACCHO gathered information on LHDs PrEP-related activities and needs via a stakeholder consultation (May 2014) and an online survey (July 2014)
Key Findings: Activities and Challenges 76 survey respondents from 26 states 22% reported that their health department provides PrEP or supports PrEP delivery HIV/STD program managers (30%) and nurses (22%) considered most likely to spearhead PrEP activities 75% reported that they did not know if another local organization was providing or supporting PrEP PrEP Services and Activities Education and outreach for community members Number of responses 10 Challenges to PrEP Implementation Cost Number of responses 28 Education and outreach for healthcare providers and other community partners 8 Lack of awareness and knowledge among LHD staff 23 Refer clients/patients to PrEP providers 6 Staff capacity 23 Deliver PrEP via health department clinic 4 Perceived or real lack of demand 22 Convene or participate in a local or state PrEP working group 1 Not sure what LHD could or should be doing 22 Other 2 Perceived or real lack of need 14 Lack of LHD staff buy-in 14 n=15 n=53 Other 12
Key Findings: Educational and Resource Needs Information about PrEP for medical providers Information for persons who might benefit from PrEP Resources for billing or seeking reimbursement for PrEP delivery Resources to guide the development of a PrEP delivery program Fact sheet/brief to educate administrators and other decision makers about PrEP Webcasts/webinars on particular components of PrEP Resources to support data analysis to help delineate the need for PrEP Development of a peer network to discuss and support PrEP implementation HIV risk screening tools Tools to assess community interest and knowledge related to PrEP Tools to assess provider interest and knowledge related to PrEP Podcasts on particular components of PrEP Least helpful 1 2 3 4 5 Most helpful n=67-68 0% 20% 40% 60% 80% 100% Percent of responses
New Data: Highlights from August 2015 Assessment of LHD Engagement in PrEP Sample size of 500 LHDs; 284 respondents; 57% response rate 109 LHDs (38%) currently engaged in PrEP implementation o o o o o Higher among LHDs serving a large population size (67%) and those in the West (52%) and Northeast (39%) Most common PrEP implementation activities: referral to PrEP (75%); community education and outreach (50%), identifying local PrEP providers (49%) 10% are prescribing PrEP from a health department clinic Questions LHDs reported struggling with the most: How will PrEP be made accessible to those most in need? What is the health department s optimal role in PrEP implementation? 53% anticipate that the health department will expand its level of engagement in PrEP Among LHDs not currently engaged in PrEP implementation, 18% expect to become engaged over the next 4 years, 36% report that it is unlikely they will become engaged, and 46% are undecided o 72% report the need for more information about PrEP among LHD staff
Key Findings: Stakeholder Consultation Education is the first step on the continuum of PrEP uptake Interest and chatter, but need for more coordinated action and increased access to PrEP Need to define public health s philosophy on PrEP how does it fit into HIV prevention? Need more information and guidance on who would benefit the most from PrEP and how to reach these individuals Need to increase awareness and knowledge of PrEP among healthcare providers Need to define what a PrEP clinic looks like Value of having a PrEP coordinator and partnering with local organizations and stakeholders Need to take a sexual health approach and to address stigma You need to have a vision for PrEP in your community and to support that vision with accurate information and resources. There isn t an infrastructure that exists at the moment, so where do we start?
LHDs and PrEP Course Curriculum Module 1: The Science of PrEP for HIV Prevention and the US Public Health Service Clinical Practice Guidelines for PrEP PrEP for HIV Prevention: An Introduction Beyond the Basics: The Science of PrEP US Public Health Service Clinical Practice Guidelines for PrEP Module 2: Who Might Benefit from PrEP? Assessing Benefit at a Population and Individual Level Who Might Benefit from PrEP: Population-level Assessments Who Might Benefit from PrEP: Individual-level Assessments Module 3: Thinking About Incorporating PrEP into Your HIV Prevention Programs? Examples and Models from Local Health Departments Increasing PrEP Awareness and Knowledge in Your Jurisdiction Incorporating PrEP into Comprehensive HIV Prevention Programs PrEP Story Bank
Public Health and PrEP Providers Local public health (PH) serves an ideal role as a connector between many parts of a broader network. Epidemiologic and effectiveness research PH At-risk persons/subgroups/ populations Prevention and screening programs
Public Health Core Functions and 10 Essential Services Useful framework for thinking about the role of LHDs across the full spectrum of PrEP implementation. Source of Ten Essential Public Health Services: Core Public Health Functions Steering Committee, 1994; ttp://www.cdc.gov/nphpsp/essentialservices.html
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 community members, healthcare providers, HIV prevention partners, and LHD staff Refer 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 Champaign-Urbana Public Health District Originally planned to conduct education and outreach with providers and community members and link individuals interested in PrEP to providers Became apparent that to better meet client needs and overcome barriers to access, it would be most beneficial to prescribe PrEP in the STD clinic Chicago Department of Public Health (CDPH) Active referral to PrEP from all five CDPH STI clinics Partner sites: Howard Brown Health Center, University of Chicago, Mount Sinai Hospital Referral for high-risk groups, including MSM and transgender women with a rectal STI or syphilis; commercial sex workers; injection drug users; and persons with an HIV positive sexual partner
LHD Examples Denver Public Health Internal referral from the STD clinic to the HIV care clinic 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 Supported by MSM-focused funding from the Minnesota Department of Health and administered through the Health Interventions for Men (HIM) program Women are referred from Red Door Services to other providers in the community
LHD Examples New York City Department of Health and Mental Hygiene Prep for PrEP conducted a programmatic needs assessment at STD clinics Developed a program that combines a public awareness campaign; outreach and support to medical clinics, including public health detailing; expanding access to PrEP and PEP; and monitoring PrEP and PEP uptake
Thank You Gretchen Weiss, MPH Director of HIV, STI, & Viral Hepatitis 202-507-4276 gweiss@naccho.org www.naccho.org/hivprep www.naccho.org/prepstorybank