PrEP Merge Ahead Steering HIV Prevention into the new landscape February 2016 Jessica Horwitz FNPC AAHIVS Alfonso LaCorte CCMA CPT CRUSHPREP Cohort Overview ContextBackground CRUSH overview ID: 783617
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Slide1
Lowering Barriers to Engage Hard to Find Communities in
PrEPMerge Ahead! Steering HIV Prevention into the new landscape February 2016
Jessica Horwitz FNP-C, AAHIVS
Alfonso
LaCorte
CCMA, CPT
Slide2CRUSH/PREP Cohort Overview
Context/BackgroundCRUSH overviewAddressing Barriers to accessing PrEP Lessons Learned
Slide3Why a sexual health clinic for young MSM? What would the model be?
New cases are increasing among MSM, and in particular African Americans young MSM/MSM of colorMSM between 18-29 made up 81% of new cases between 2010-2012 in AC
ACA/Covered CA meant push to get younger people enrolled in health service
NO municipal/public
supported STI clinic in Alameda
County
Slide4EBAC and Downtown Youth Center
East Bay AIDS Center…..Downtown Youth Clinic (1997)HIV primary care center, psychosocial, and peer treatment based services for HIV + youth (13-29 yrs)
“Clinic without walls”:
Linkage
and retention,
TAKEN TO
clients- at their homes, at other agency
sites; clinic
cellphones and communicate with clients via text messagingEnhanced access: Flexible drop in provider availability; non punitive if missed appointments; Approx. 220 HIV Positive youth <29 Over 80 % MSM70% virally suppressed
Slide5Establishing a Model Sexual Health Clinic: CRUSH PROJECT
California HIV/AIDS Research Project: Epidemiological Interventions Initiative (EII)Novel approaches to addressing the HIV prevention care and treatment continuum (PrEP-TLC +)
Funded April 2013, 4 years, 3 sites in CA: multi- million state wide investment
Goal of CRUSH:
To integrate routine sexual health services for Y/MSM within the setting of an existing HIV primary care clinic (including the provision of PrEP)
Slide6HIV Negative CohortFirst participant enrolled on 2-10-2014Last participant enrolled on 11-6-2015281 total participants
177 currently enrolled66 have completed follow up21 are past 12 months and lost to follow-up17 discontinued before 12 months
FINAL DATA
Slide7Who is choosing PrEP?Ethnicity
Referral Source
FINAL DATA
252 individuals, predominantly male. Age:
24.7 ± 2.9
Slide8Barriers to Accessing PrEPNO municipal/public supported STI clinic in Alameda County
Lack of insurance and primary care servicesTransportation Primary care providers lack of experience and comfort prescribing PrEP
What is sexual health?! Prevention
vs
Treatment
Shame and stigma
Slide9Reducing Barriers to PrEP Access Open door clinic without strict appointment timesRetention Coordinator
Patient Navigation: warm handoffs Benefits Counselor Patient Assistance Program navigation Sex positive clinical environment – from start to finish
Slide10PrEP Retention and Adherence Support
PrEP Navigation & Retention Coordinator:First point of contact, patient navigator, back up test counselorPeer support
Weekly review of missed visits, medication pick up’s
Text reminders for up coming visits, questions
Visit navigation and warm hand-offs
Slide11Accessing PrEPBenefits Counselor InsuranceExplanation of current benefits and out-of-pocket costs
Patient Assistance Program navigation Co-Pay Card PEP Access Patient Assistance for those without health insurance
Slide12Lessons Learned: integrating Sexual Health/PrEP initiatives
Clinical:
10% at baseline seeking PrEP actually need PEP:
Solidify warm hand-off for primary care services for HIV negatives
Administrative:
Cross-training staff: HIV testing, intake, consent, lab processing, referrals
Administrative challenges working within a hospital system
Developing & documenting clinical flow is crucial & ever changing
Strengthening intra-agency collaboration ultimately helps with clinic flow
Developing assessment tools for clinical and program staff to address the PrEP to PEP interplay
Increased STI treatment 3 fold: Nurses were like “WHAT????”
Slide13Lessons Learned
Community:Establishing a robust Community Advisory BoardDiscussion with partners “What does sexual health mean? What are the outreach messages for Y/MSM?”
Your patients are your strongest referral site- good and bad
Slide14Acknowledgements:
Our Funder: CHRPThe CRUSH and DYC Team at EBACOur UCSF/CAPS Evaluation Team
Our CAB and community partners