Universalize PrEP & HIV Education

Provide universal PrEP/HIV prevention awareness and education to ALL clients, not just those who fit certain "risk profiles" or "target populations." Increasing access means giving information to everyone, not just those perceived as likely PrEP users or easiest to reach. Data suggest that universal HIV/STI screening is more beneficial and cost-effective than risk-based approaches.^{1, 2}

“I provide the information [about PrEP] to everyone. Sometimes they don’t think that they’re a good fit for PrEP until they go back out and say, ‘Oh, you know what? Maybe I am living a city-boy life,’ or, ‘Maybe I am getting around a little bit,’ and then that’ll make them reconsider things.” — Program Coordinator, South

Deliver Comprehensive PrEP Options Counseling

Offering a range of prevention options increases uptake and persistence.¹ But REAL choice requires that users fully understand their options.² Potential and current PrEP users deserve to understand the advantages and drawbacks of each HIV prevention method, including side effects, cost, and implications for discontinuing or switching. At the same time, focusing solely on biomedical interventions like PrEP and PEP may shift focus away from other vital components of a person's prevention plan, such as consistent condom use or harm reduction. By presenting a full menu of choices and discussing WHY users might want to make a particular choice, we empower users and foster a sense of agency and ownership over their health.

“I talk to them about their sex life. I need to know you as a person. It makes it easier for you to be honest. It helps me navigate your care better and meet your needs better. So I want to know what your dreams are. I see them as a person, and I treat them as such. They matter… I don’t just talk about PrEP. I talk about their lives and what’s happening with them, and then PrEP comes along.” — PrEP Navigator, Southeast

Center the User's Experience & Needs

Every experience and interaction a client has with medical care impacts them—emotionally and cognitively.¹ Small changes that demonstrate understanding of a client's perspective can significantly improve outcomes and engagement.² Program implementation should reduce barriers to care—not add to them. Consider, for example: extended clinic hours, walk-in appointments, integrated wrap-around services, and a welcoming environment that prioritizes patient comfort and confidentiality. When care infrastructure is built around the client, it not only improve engagement and retention but also fundamentally address the systemic obstacles that have historically hindered access to healthcare.^3,4

Select & Empower a Program Champion

A PrEP program champion should be a dedicated and passionate advocate who understands the clinical, operational, and financial complexities of a new intervention and acts as the driving force for change. The most effective champions have clinical authority, true decision-making power, and institutional clout.¹ A champion's role is to build consensus, address skepticism, and troubleshoot barriers as they arise.² Their ability to coordinate across colleagues and disciplines is essential for navigating the inevitable challenges of implementation. This ensures that the new modality is not only adopted but also successfully integrated into the clinic's standard of care.

"Our navigators are very passionate. They are the [PrEP Program] champions. They are completely the champions. I do not think if they were not the spokespersons and the champions of the program, I don't know that it would've taken off the way it has." — Health Services Manager, South

Optimize Work Flows

Comprehensive PrEP provision can have a lot of steps and moving parts. Effective programs have embraced task-shifting, cross-trained staff, redesigned clinic workflows, partnered with outside vendors for support, and utilized electronic tracking tools. Focusing on workflow can help streamline tasks and division of labor, and can ensure that all the moving pieces of PrEP implementation are in place.¹ Task shifting can be helpful in redistributing workflow, improving efficiency and maximizing the use of available resources to enhance patient care.² Electronic tools and other tracking systems are workflow aids that can help patient navigators and other support staff provide timely reminders and other check-ins for clients.

"Sometimes it's traumatizing and traumatic, and gives people anxiety to keep seeing different people, different people ... Our case manager, he's a medical assistant too, so he does case management, so he can bring you in and do everything from your case manager to drawing your blood for the provider, and you go on about your business with seeing just one person." — Program Director, South

Devote resources to Cost & Coverage

Newly approved therapies introduce a complex web of prior authorizations, a patchwork of payer policies, and inconsistent coverage under pharmacy or medical benefits. Without dedicated staff and robust systems to manage these administrative hurdles, the high cost of medication and lack of transparency can create financial strain for both the clinic and clients.

"We had to put a lot of thought and work into the insurance approval process... it's a beast, and it's an ongoing beast. There's a lot of variability in terms of whether this is covered as a pharmacy benefit or a medical benefit. Almost always, it needs to go to appeals and prior authorizations. There's tons of variability from insurer to insurer in terms of how easy or difficult and how many barriers they throw up in this process." — Prevention Manger, MidAtlantic

Embrace Sex Positivity

Instead of framing sex as inherently dangerous or focusing solely on the risk of infection, a sex-positive approach acknowledges that consensual sexual activity is a natural and healthy part of human life.¹ This shifts the focus from managing risk of infection to pleasure and empowerment. Interest in and acceptance of PrEP is increased when HIV prevention is presented in the context of sexual wellness.^2,3

Lead With Values & Document Decisions

The clinic's values provide the 'why'—the underlying basis for clinical decisions. Protocols provide the 'what' and 'how'—the step-by-step guidance that ensures consistency, safety, and quality of care. When a clinic’s values are explicitly articulated and transparently documented, they create a solid foundation for an HIV prevention program.¹ Protocols become more than just rules; they become a practical expression of the clinic's deepest commitments, ensuring that every action taken by staff is not only technically correct but also ethically and morally aligned with the program's mission.

"Yes, it's a huge lift, I think for a structure, a clinical structure, and I think that part is difficult, but I think especially being a public health/ sexual health clinic, it is important to meet the needs of the community." — Clinic Administrator, West

Create a Culture of Collaboration

Injectable PrEP programs hinge on a truly collaborative clinic. Clients benefit from clear, standardized handoffs between team members, shared knowledge about their cases, and seamless communication among their providers. A culture of collaboration improves the overall energy of the clinic: mutual respect and a problem-solving mindset help clients feel supported and confident in their care, while also fostering staff satisfaction and motivation.¹

Leverage Data

A good injectable PrEP program is about more than delivering injections; it’s an iterative process of development and refinement. Measuring what matters is essential—from tracking patient education and missed and on-time appointment rates, to monitoring follow-up on injection site reactions and ensuring timely, comprehensive HIV/STI testing. Learning from both successes and challenges strengthens care. Clinics with standardized practices for collecting and reflecting on program data are better positioned to improve their programs and achieve the greatest impact.

Adapt as More Information Becomes Available

The strongest programs are flexible, responsive, and open to new developments and data as they arise. As new information and best practices emerge, we need to stay on top of the details and revise our protocols and programs to best meet the needs of our clients and staff.

“We need to pilot something and get it in motion, because you can talk so much about how it's going to work, but we need to have at least one or two cases to work through the kinks of what we're seeing, to make it better. My hope is to take what we learned in this situation and then start another site and then build.” — Clinician, West

Go Where the People Are

Increasing PrEP access means going outside traditional delivery settings and forging new cross-disciplinary partnerships.¹ We need to build capacity and engage a variety of providers across settings—from emergency departments and family planning clinics to safe injection sites and transitional housing.^{2, 3} PrEP providers have an opportunity and responsibility to reach new users by thinking "outside the box" and imagining new program models and settings.

"[We have] a partnership with the ID exchange right down the block. And they do the syringe exchange...there's a pretty large population of injection drug users, and a lot of them could benefit from PrEP. So we're trying to be there so that they can see us every week...people can exchange needles on our mobile...So it's kind of like we bundle the services with the ID that day just to bring that population in, but then also be able to educate about our services at the same time." — Project Manager, Southeast