Pr E Pping for a Br ave Ne w Wor ld: Innovations in De live r - PowerPoint PPT Presentation

Pr E Pping for a Br ave Ne w Wor ld: Innovations in De live r y at the De tr oit Public He alth ST D Clinic Christine He uma nn, MD, MPH Me dic a l Dire c tor, De troit Public He a lth ST D Clinic Assista nt Profe ssor Of Me dic ine , Wa yne Sta te Unive rsity

Ove r vie w • Program History • Current Practices • Ongoing Research

Public He alth ST D Se r vic e s in De tr oit, Mic higan • City of Detroit filed bankruptcy in summer of 2013 • Herman Kiefer Health Complex, which housed the city’s sole dedicated STD clinic, closed in late 2013 • MDHHS contracted with Wayne State University School of Medicine to host the Detroit Public Health STD Clinic in fall of 2014; clinic moved to permanent location in spring of 2016

De tr oit Public He alth ST D Clinic • Initial PrEP program – started in early 2016: • No systematic screening; patients could self refer for PrEP or clinician could offer • Patients had initial visit that included counseling and lab work • Asked to return within 1 week for oddslot tips PrEP prescription • Few patients initiated PrEP • Current PrEP program: • Patients can receive PrEP prescription same day – September 2016 • Systematic screening of all patients for PrEP eligibility criteria – January 2017 • Now the largest PrEP prescriber in Michigan

Cur r e nt Pr ac tic e s

Sc r e e ning for Pr E P E ligibility  Use sta nda rdize d form to a sk e ve ry pa tie nt a bout:  Ge nde r o f se x pa rtne rs  Se xua l pra c tic e s  HI V sta tus o f se x pa rtne rs  Co mme rc ia l se x wo rk  I ntra ve no us a nd o the r drug use  Histo ry o f se xua lly tra nsmitte d infe c tio ns  Sta nda rdize d form a lso inc lude s PrE P e lig ibility a sse ssme nt

Pr E P E ligibility Asse ssme nt

Same Day Pr E P  If patie nt me e ts Pr E P e ligibility c r ite r ia, the n c linic ian offe r s patie nt Pr E P same day  If patie nt ac c e pts the n:  Risk/ b e ne fits disc ussio n  Ra pid HI V te st, c re a tinine c le a ra nc e , urine dipstic k, He p B & C sc re e ning , ST D sc re e ning , pre g na nc y te st (sta te funding fo r uninsure d pa tie nts’ la b wo rk)  I nve stig a te pre sc riptio n c o st, c o nside r fina nc ia l a ssista nc e pro g ra ms a nd insura nc e e nro llme nt (PrE P c o o rdina to r a nd fina nc ia l c o unse lo r)  Pre sc riptio n g ive n sa me da y fo r 30 da ys (if HI V te st no n-re a c tive a nd urine dipstic k witho ut pro te in)

Ongoing Re se ar c h

Imple me nta tion And E va lua tion of HIV Pre - E xposure Prophyla xis (PrE P) in De troit: A Public He a lth- Ce nte r for AIDS Re se a rc h (CF AR) Colla bora tion NIH Supple me ntal Gr ant to CDC Pr oje c t Pr IDE Collabor ation be twe e n: Mic higan De par tme nt of He alth and Human Se r vic e s, Wayne State Unive r sity, and Unive r sity of Washington

Imple me ntation and E valuation of Pr E P in De tr oit Ove ra rc hing g oa l: T o de ve lo p a nd e va lua te a po pula tio n- b a se d, pub lic he a lth a ppro a c h to PrE P in De tro it Aims: Mo nito r PrE P upta ke : c o unty a nd sta te wide e va lua tio ns 1. In the De troit Public He a lth ST D Clinic : E va lua te pub lic he a lth PrE P pro visio n 2. I de ntify PrE P no n-initia tio n a nd disc o ntinua tio n 3.

Imple me ntation and E valuation of Pr E P in De tr oit Provide s funding for PrE P Coordina tor 1) Me e ts with e ve r y patie nt inte r e ste d in and/ or pr e sc r ibe d Pr E P  Pro vide s e duc a tio na l ma te ria l, a ssists with pa tie nt a ssista nc e pro g ra ms, se rve s a s lia iso n b e twe e n pa tie nts a nd pro vide rs, re minds pa tie nts o f a ppo intme nts a nd c a lls if misse d a ppo intme nts 2) Study e nr ollme nt for pr ospe c tive Pr E P c ohor t  I nitia l visit: Additio na l da ta c o lle c te d o n se lf-e ffic a c y, inte rna lize d ho mo pho b ia , pe rc e ive d risk o f HI V, c o mmitme nt to PrE P (se lf a nd pro vide r pe rc e ptio n)  F o llo w up visits: Ask a b o ut a dhe re nc e , re a so ns fo r misse d do se s a nd a ppo intme nts, c o ntinue d ne e d fo r PrE P 3) Maintains RE DCap database  I nputs da ta fro m sta nda rdize d fo rm/ PrE P e lig ib ility a sse ssme nt fo r e a c h pa tie nt visit

Pr e liminar y Pr ogr am E valuation DCap Database : 1,736 pa tie nts se e n b e twe e n Ja nua ry 17, 2017 a nd June RE 30, 2017  84% Afric a n Ame ric a n/ b la c k, 67% ma le , a nd 15% MSM  145 me t a ny PrE P e lig ib ility c rite ria  91% we re MSM who re po rte d c o ndo mle ss a na l inte rc o urse a nd/ o r a re c e nt ST D  94 we re o ffe re d, 58 a c c e pte d, a nd 40 pre sc rib e d PrE P  Clinic ia ns a lso o ffe re d PrE P to 47 pa tie nts who did no t me e t PrE P e lig ib ility c rite ria  49% we re MSM  13 a c c e pte d, 11 pre sc rib e d PrE P

Ne xt Ste ps  E va lua te re a so ns why the re is lo ss a t e a c h ste p a lo ng the PrE P c a re c o ntinuum a nd try to impro ve upo n the m  I mple me nt We lT e l two -wa y te xt me ssa g ing pro g ra m to impro ve c o mmunic a tio n b e twe e n PrE P c o o rdina to r a nd pa tie nts  Co lle c t da ta fo r pro spe c tive PrE P c o ho rt thro ug h Ma y 2018  Ga in in-de pth kno wle dg e a b o ut pa tie nt pe rc e ptio ns o f se lf-e ffic a c y a nd risk, PrE P a dhe re nc e , re a so ns fo r disc o ntinua tio n, e tc .  Co nstruc t a risk sc o re pre dic tive o f e a rly PrE P disc o ntinua tio n

T ha nk yo u c he uma nn@ me d.wa yne .e du