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

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May 06, 2023 256 likes •428 views

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

SLIDE 1

Pr E Pping for a Br ave Ne w Wor ld: Innovations in De live r y at the De tr

it 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

SLIDE 2

Ove r vie w

Program History
Current Practices
Ongoing Research

SLIDE 3

Public He alth ST D Se r vic e s in De tr

it, 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

SLIDE 4

De tr

it 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

SLIDE 5

Cur r e nt Pr ac tic e s

SLIDE 6

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

SLIDE 7

Pr E P E ligibility Asse ssme nt

SLIDE 8

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)

SLIDE 9

Ongoing Re se ar c h

SLIDE 10

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

je 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

SLIDE 11

Imple me ntation and E valuation of Pr E P in De tr

Ove ra rc hing g oa l: T

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

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

I de ntify PrE P no n-initia tio n a nd disc o ntinua tio n

SLIDE 12

Imple me ntation and E valuation

f Pr

E P in De tr

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

llme nt for

spe 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

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

SLIDE 13

Pr e liminar y Pr

am E valuation

RE DCap Database: 1,736 pa tie nts se e n b e twe e n Ja nua ry 17, 2017 a nd June

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

 94 we re o ffe re d, 58 a c c e pte d, a nd 40 pre sc rib e d PrE

 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

SLIDE 14

SLIDE 15

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

SLIDE 16

T ha nk yo u

c he uma nn@ me d.wa yne .e du