REAL WORLD PROGRAM STRATEGIES

Our BLUPrInt Team has interviewed staff at sites across the country about the ways in which they do each of the components of a PrEP program.

Click on the strategies below to learn more about how they have been used to support patients!

  • Some sites increase PrEP awareness and normalize HIV prevention by making sure that educational materials (flyers, brochures, posters, even videos!) are present in their waiting rooms and other clinic areas. Click here for some resources!

  • Some clinics make sure they provide basic PrEP education (what is it, what it does, how patients can access it) to ALL patients, regardless of whether the provider thinks they are “high-risk” or might benefit from PrEP. This universal education normalizes PrEP use and sexual health and increases general awareness of PrEP in the larger community.

  • Some clinics create an “trigger” in their EMR that reminds providers to educate certain high-priority patients about PrEP. The most commonly used trigger flags patient who have had an STI in the past year. The trigger alerts providers to be sure to educate these patients about PrEP and offer PrEP to these patients.

  • Some clinics conduct routine HIV/STI testing by default for all patients unless they specifically “opt-out” or refuse testing. This strategy works particularly well in clinics in areas with high HIV/STI incidence, but all clinics can use opt-out testing for specific visit types (like annual physicals). Opt-out testing should be explained to patients (“I test all my patients for HIV and STIs…”) and opens the door for sexual health conversations and PrEP education (“…because sexual health is such an important part of overall health.) For more on this, see the GOALS Approach to Sexual Health.

  • Some clinics make sure that they provide PrEP education and provide brochures or other materials to any patient receiving related services in the clinic (e.g., STI testing or pre/post natal care). This strategy ensures that as many patients as possible are aware of PrEP and can access it. Click here for more patient education resources.

  • Some sites are able to provide a PrEP prescription to patients on the same day that they express interest. Both WHO and CDC have guidelines fro same-day starts, and encourage them! Same-day starts leverages patients’ motivation to begin PrEP and communicates to them that the health system can “work” for them. You can find information and guidance for same-day start in our BLUPrInt materials or from the National HIV PrEP Curriculum

  • Data show that patients get HIV when they run out of their PrEP pills…so making sure that patients have enough pills on hand is extremely important. Some research shows that providing more pills at PrEP initiation (90 days as opposed to 30 days) is associated with greater patient retention and longer sustainment of PrEP use. Providing more PrEP pills also communicates trust to patients.

  • Some clinics allow patients to self-test for HIV or STIs at home and send screen-shots of the test results, as opposed to having to come back to clinic for testing every 3-months. Other clinics let patients go to labs with longer hours (evenings or weekends) or walk-in services. Any strategy that decreases visit burden for patients is likely to increase their retention in care…and their trust in you!

  • Some clinics reduce costs and increase capacity by training community health workers as phlebotomists and PrEP counselors. These staff members can see patients for follow-up visits, reducing the burden on MDs/PAs/NPs at the clinic. Some clinics have trained CHW to administer PrEP injections. You can read a presentation about this approach here.

  • Some sites work to increase efficiency for their patients by decreasing the number of visits patients need before they start PrEP (see same-day start, above), reducing the number of clinic visits by self-testing or other lab access (see above), training staff to conduct multiple components of the visit (e.g., the counselor is also a phlebotomist) or scheduling all PrEP visits in the same clinics session (to routinize workflow). Streamlined visits help staff, but they also make a huge difference to patients, who are often juggling multiple responsibilities to make the time to come to clinic.

  • Clinics are increasing the use of Telehealth for PrEP visits. You can access a great PrEP teleheath planning tool here and learn more about approaches here.

  • To mitigate barriers in seeking PrEP, some sites provide HIV prevention services to patients who walk into clinic without an appointment.

  • Some clinics try to accommodate their patients’ busy lives and competing responsibilities (work, child care, elder care) by increasing appointment availability during weekends or evening hours. Other sites have collaborated with community-based organizations that are open late to station a single provider who can provide follow-up PrEP care and prescriptions.

  • Patients have a lot of anxiety about injectable PrEP, and some clinics have transformed their iPrEP rooms by providing injections on a massage table (rather than a standard exam table) , playing relaxing music in the visit room, or having posters that create more of a “spa” rather than “clinical” atmosphere. You can see a picture of this type of room in this presentation about PrEP provision by community health workers..

  • Some clinics allow patients to text their PrEP counselor or navigator. Bidirectional texting can improve attendance at iPrEP injection visits, and can also be used to check-in about side effects or other concerns.

  • Some sites find that transportation is the biggest barrier to appointments for their patients. Some provide direct financial support for transportation (bus or subway passes) or partner with taxi companies to provide assistance. Some of the most popular car companies have specific patient-access services; learn more here or here.

  • Some clinics have a protocol to check-in with patients 1-2 weeks after they start oral PrEP, to ask about side-effects and their experience being able to take the medication regularly. Many clinics also check in with iPrEP patients within the first week of initiation about side effect management. Data indicate that these types of check-ins improve patient retention, and make it more likely for patients to reach out later if they are having problems.

  • Clinics have increased access to language lines and translation services, which increases communication with patients. But data indicate that patients benefit from having a provider to whom they can speak DIRECTLY, in the language they are most comfortable. Many clinics make sure to hire staff who can speak languages spoken by a sizable population of their patients.