Models of HIV Pre-Exposure Prophylaxis Care Used in Title X Family Planning Clinics in the Southern U.S.

TitleModels of HIV Pre-Exposure Prophylaxis Care Used in Title X Family Planning Clinics in the Southern U.S.
Publication TypePublication
Year of Publication2021
AuthorsPiper KN, Escoffery C, Sales JM, Sheth AN
JournalJ Adolesc Health
Volume68
Issue3
Pagination480-487
Date Published2021 03
ISSN1879-1972
KeywordsAdolescent, Ambulatory Care Facilities, Anti-HIV Agents, Family Planning Services, Female, HIV Infections, Humans, Pre-Exposure Prophylaxis, Young Adult
Abstract

<p><b>PURPOSE: </b>HIV pre-exposure prophylaxis (PrEP) is underutilized by adolescent and young adult women, especially in the Southern U.S. Family planning (FP) clinics are potentially ideal PrEP delivery sites for adolescent and young adult women, but little is known about their PrEP services. We describe models of PrEP care in Title X FP clinics in the South and explore clinic resources that are needed to facilitate PrEP provision.</p><p><b>METHODS: </b>Providers and administrators from 38 clinics participated in qualitative interviews. We assessed five steps of PrEP care: (1) HIV risk assessment; (2) PrEP education; (3) laboratory testing; (4) PrEP prescription; and (5) PrEP monitoring.</p><p><b>RESULTS: </b>Among 38 clinics, 23 conducted at least one step and were classified into three models. Model 1 (n = 8) and Model 2 (n = 4) clinics provided up to Steps 1 and 2, respectively, but referred to an external PrEP provider. Model 3 clinics (n = 11) conducted all steps. Few barriers were identified for Step 1; using an HIV risk assessment tool was a key facilitator. PrEP educational materials facilitated Step 2; clinics not providing education believed they could easily do so with training and educational resources. Funding- and staff-related resource barriers were noted for Steps 3-5, including costs of laboratory tests and lack of time for longitudinal visits.</p><p><b>CONCLUSIONS: </b>PrEP-providing publicly funded FP clinics in the Southern U.S. use referral services for many steps of PrEP care, which introduce patient burden. Increasing onsite PrEP services will require addressing concerns related to training, educational materials, cost, and staffing.</p>

DOI10.1016/j.jadohealth.2020.10.005
Alternate JournalJ Adolesc Health
PubMed ID33160826
PubMed Central IDPMC7902302
Grant ListP30 AI050409 / AI / NIAID NIH HHS / United States
U24 HD089880 / HD / NICHD NIH HHS / United States