Integrating PrEP for HIV in a Categorical STD Clinic within a High Risk Urban Setting

Background: Health Center #1(HC1), a categorical STD clinic with over 20,000 patient visits yearly, serves many of the highest risk patients for new HIV. In 2014, over 60 new HIV infections were discovered through screening at HC1, overwhelmingly new infections were among young MSM of color. There were 17 new HIV infections detected among patients with a negative test in the previous 2 years; all would have met criteria for PrEP.

Methods: HC1 staff were provided training by PrEP providers prior to policy development and implementation. HIV negative patients 18 years or older who were determined to be high risk for HIV or requested PrEP were referred by a clinician to social work staff.  Additional counseling and appointment for PrEP were given.

Results: From August 15, 2015 through March 23, 2016 HC1 enrolled 44 (42 male and 2 female) patients in its PrEP program. Of the 44 patients, 30 are Philadelphia residents, 39 are MSM, 17 are white-non Hispanic, and 26 are under 30 years of age. Ten patients are uninsured and have received medication through a patient assistance program. Since PrEP initiation, 4 patients were diagnosed with new STIs, 1 GC, 1 Chlamydia, and 2 Syphilis. Of the 44 patients with initial evaluation and prescription, 40 have had at least one follow up appointment. To date, none of the patients started on PrEP at HC1 have become HIV positive.

Conclusions: PrEP management is feasible in an STD clinic that is not co-located with HIV care and that does not otherwise take insurance. The biggest challenge is acquiring medication for uninsured patients. Though MSM of color are at the highest risk for HIV acquisition and comprise the majority of PrEP referrals they are underrepresented. Strategies for increasing the enrollment of those at highest risk for HIV acquisition should be considered.