Implementation of a Pre-exposure Prophylaxis (PrEP) Program for HIV Prevention in a Federally Qualified Health Center (FQHC)

Abstract

Introduction/Purpose: Preventing new cases of Human Immunodeficiency Virus (HIV) infection is key to the Centers for Disease Control and Prevention (CDC’s) Ending the HIV Epidemic: A Plan for America initiative. In 2012, Truvada became the first medication approved in the United States to prevent HIV infection, yet it has not seen widespread use. Research has shown that healthcare provider awareness and attitudes are common barriers to pre-exposure prophylaxis (PrEP) prescribing. Alleviating these barriers requires that primary care providers (PCPs) receive the tools and knowledge to quickly address HIV risk factors and offer PrEP to their patients who need it. The purpose of this project is to determine if an educational session for healthcare providers and the introduction of an HIV Risk Assessment Tool into an EHR will decrease barriers to offering PrEP. Methods: An educational program was provided to the Internal Medicine/Family Medicine (IM/FM), Obstetrics & Gynecology (OB/GYN), and Pediatric healthcare providers in an urban federally qualified health center (FQHC). This program presented current guidelines regarding the assessment, management, and follow up of patients who are candidates for PrEP and was conducted during departmental group meetings. This education included using an HIV Risk Assessment Tool, which was introduced into the EHR during the training sessions. A questionnaire was administered to all healthcare providers at the health center before and after participating in the educational program. The use of the HIV risk assessment tool was queried, utilizing an EHR report after the project. Results: 5 Pre- and post-intervention questionnaire data were compared to determine the effect of the intervention. Provider likelihood to prescribe PrEP to specific groups and in particular situations increased among the IM/FM (P=.0001, P=.0001) and OB/GYN providers (P=.0034, P=.0034), but there was no significant change among the Pediatric providers (P =.4227, P=.1965). There were only three recorded uses of the HIV risk assessment tool. Discussion: Although there was increased awareness and acceptance of PrEP, the HIV risk assessment tool's use was minimal. These results suggest that provider willingness to prescribe did not translate into increased PrEP conversations with patients. The lack of significant change among Pediatric providers indicates a need for additional assessment of the barriers facing these providers and further support to promote acceptance of PrEP. Additional efforts are needed to progress from awareness and acceptance to incorporation of PrEP in the PCP visit.