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Background: In Los Angeles County, we began offering HIV pre-exposure prophylaxis (PrEP) to patients at high risk for HIV at two STD clinics with no current capacity for third party billing or benefits navigation. We describe barriers to transitioning patients out of the clinics for ongoing PrEP.
Methods: After the PrEP initiation visit, patients received a discharge planning interview about their income, medical provider, and insurance status to identify opportunities to transition them to another provider. Interview notes were later analyzed to identify the key barrier to transitioning out.
Results: During the first six months of PrEP at one of the STD clinics, 41 of the 49 patients started on PrEP received a discharge planning interview. The median age was 29, and the majority (n=39) were men. Thirty-nine percent were White, 36% Latino, 15% Black, and 10% Asian. Of 41 patients, 39 were not able to identify a clear transition plan to another medical provider. Eight (20%) patients were not eligible for health insurance due to their residency status. Nineteen (49%) patients needed benefits navigation because they were either uninsured and needed assistance enrolling in Medicaid or the California health insurance exchange, or were insured and needed assistance utilizing financial assistance programs to be able to afford PrEP. Ten (26%) were insured but needed referrals to other PrEP providers because they either could not get or were not comfortable asking for PrEP from their existing provider. Two (5%) were insured but had confidentiality concerns in utilizing insurance under another family member’s name.
Conclusions: Local health jurisdictions planning to offer PrEP to high risk patients in their STD clinics should consider investing additional resources in benefits navigation and establish a robust referral network of community PrEP providers to support the long term delivery of PrEP for their uninsured and underinsured patients.