Conference Coverage

HIV PrEP facing challenges, but implementation outlook positive

Publish date: October 11, 2016
By
Deepak Chitnis

 

ATLANTA – Implementation of HIV preexposure prophylaxis (PrEP) by local health departments in the United States faces several challenges, but the majority of those already engaged plan to increase their participation soon, a study showed.

“For the purposes of this study, we very broadly defined engagement in PrEP implementation as anything from participating in a local or statewide working group, to planning and supporting implementation of PrEP, to doing community education and outreach, or working with providers to deliver PrEP via health department clinics,” explained Gretchen Weiss, director of HIV, STI, and viral hepatitis at the National Association of County and City Health Officials in Washington, D.C.

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Ms. Weiss and her coinvestigators surveyed 500 local health departments (LHDs) from across the United States, of which 284 (57%) responded to the survey. Of those that responded, 109 (38%) reported that they are actively engaged in HIV PrEP in their clinics. LHDs serving larger jurisdictions, classified as 500,000 people or more, were more likely to have implemented PrEP than those in smaller jurisdictions of 50,000 people or less: 67% vs. 21%, respectively. Additionally, LHDs in the Western United States were more likely to be engaged in PrEP than were those in other parts of the country.

A total of 53% of LHDs now engaged in PrEP implementation anticipate expanding their engagement soon, 39% responded that they were unsure about expanding, and 8% said that they did not plan to expand PrEP engagement. Of the LHDs not currently implementing PrEP, 18% reported that they plan to implement PrEP within the next 4 years, while 46% were undecided, and 36% said they had no plans to implement PrEP, Ms. Weiss reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

Of the 109 LHDs using HIV PrEP, 75% reported that they are referring individuals at high risk for sexually transmitted diseases to PrEP, while 50% said that they conduct community outreach and education regarding the benefits of using PrEP. When asked what they viewed as their “optimal role” with regard to PrEP, 77% said that it was referring high-risk individuals for treatment. Sixty-five percent reported that their optimal role was to identify PrEP providers and develop referral lists, while 33% thought that delivering PrEP via health department clinics was the optimal role for their engagement in PrEP.

“In terms of the challenges faced by LHDs, 64% reported limited staff capacity, 57% reported concerns about financial access to PrEP, and 47% responded not having enough providers that are willing to provide PrEP,” Ms. Weiss said. “Thirteen percent reported that they didn’t face any significant challenges.”

No funding source for this study was disclosed. Ms. Weiss did not report any relevant financial disclosures.

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