PrEP Case Management: Retention Outcomes for HIV Vulnerable PrEP Initiates

Background: While PrEP is a formidable HIV prevention tool that could help change the course of HIV infections in the US, inadequacies in health care infrastructure have left HIV vulnerable populations with many challenges to accessing PrEP. These barriers have prevented populations such as Black and Latino young men who have sex with men (BLYMSM) and transgender women of color (TWOC) from uptake and retention of PrEP despite high incidence of HIV infection. In July 2015, Howard Brown Health, one of the Midwest’s largest LGBT health care providers, implemented a PrEP case management program to provide retention and adherence support for HIV vulnerable PrEP initiates. Intervention support was given to participants for the first four months of PrEP care. Program outcomes for retention to PrEP care in BLYMSM and TWOC were evaluated.

Methods:  PrEP appointments for BLYMSM and TWOC were tracked through Howard Brown Health’s electronic medical records system. Attendance of first (one month) and second (four month) follow-up PrEP appointments was calculated for patients initiating PrEP at any point between July 2015 and April 2016. Attendance results were compared between those enrolled and not enrolled in PrEP case management.

Results:  BLYMSM and TWOC with PrEP case management were more likely to attend their first follow-up (65%, n=24) and second follow-up appointments (16.7%, n=4) than those without case management (35%, n=61, and 14.8%, n=9).

Conclusions:  PrEP case management increased BLYMSM and TWOC’s retention to PrEP care. Drop-off between first and second follow-ups may be due in part to PrEP initiation dates falling later in the July 2015 and April 2016 date range, as appointments may be pending. PrEP case management’s impact on appointment retention is critical to enabling PrEP adherence and lowering HIV incidence rates in BLYMSM and TWOC.