Implementing PrEP in STD Clinics: Findings from a 2015 Assessment of Local Health Department Engagement in PrEP Implementation

Background:  The US Public Health Service released clinical practice guidelines for daily oral preexposure prophylaxis (PrEP) in May 2014, however, uptake has been slower than expected and uneven. Local health departments (LHDs) will play a key role in delivering PrEP for HIV prevention, including through STD clinics, which serve a critical population for PrEP.

Methods:  In 2015, the National Association of County and City Health Officials (NACCHO) conducted a survey to assess LHD engagement in and resources needed for PrEP implementation. A sample of 500 LHDs was randomly drawn by region (Midwest, Northeast, South, West) and population size served (<50,000, 50,000-499,999, 500,000+) from 1,364 LHDs that provide HIV or STD screening and/or treatment, according to a 2013 NACCHO study.

Results:  Fifty-seven percent responded to the survey. Of responding LHDs, 38% reported engagement in PrEP implementation. Among these, 81% operate an STD clinic, of which 7% prescribe PrEP from the clinic and 81% have a place for PrEP referral. When asked for optimal role in PrEP implementation, 38% of LHDs engaged in PrEP implementation reported prescribing PrEP from a LHD clinic and 80% reported referring high-risk individuals to PrEP. Among all respondents that operate an STD clinic, 52% reported having sufficiently trained personnel to screen for PrEP indications (72% among respondents engaged in PrEP; 37% among respondents not engaged in PrEP). Only 18% reported having sufficiently trained personnel to assist patients on matters related to paying for PrEP (30% among respondents engaged in PrEP; 8% among respondents not engaged in PrEP).

Conclusions:  STD clinics may play a critical role in the scale-up of PrEP. While knowledge gaps and limited resources challenge implementation, this study shows that LHDs intend to increase PrEP engagement. Increased information, resources, and research on implementation and financial coverage strategies are needed to support increased PrEP activities within the STD setting.