David Katz PhD MPH University of Washington Public Health Seattle amp King County Integrating PrEP into STD Partner Services in Washington State STD PS present an opportunity to provide populationbased HIV prevention to ID: 760031
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Slide1
NCSD EngageNovember 16, 2017
David Katz, PhD MPHUniversity of WashingtonPublic Health – Seattle & King County
Integrating
PrEP
into STD Partner Services in Washington State
Slide2STD PS present an opportunity to provide population-based HIV prevention to people at high riskIn 2012, WA State began integrating interventions across HIV prevention/care continuumPrEP referralHIV testingHIV/STI testing remindersEngagement in HIV careSimultaneously prioritized MSM for PSMSM account for >2/3 of HIV infections in WAFacilitated by gender of sex partners on case report
STD Partner
Services (PS
) in Washington
State
Slide3King County PS Program & PrEP Referrals
1http://www.kingcounty.gov/healthservices/health/communicable/~/media/health/publichealth/documents/hiv/PrEP-Implementation-Guidelines.ashx
Offer referral to PrEP at public health STD clinic or community providers
HIV-negative MSM at high risk1early syphilis or rectal GCmethamphetamine or poppers usesex workHIV-unsuppressed partnerBlack or Latino
Offer referral to community providers for PrEP
HIV-negative MSM at lower riskCT or urethral/pharyngeal GC without behavioral risk
DIS attempt to provide partner services to MSM w/ STIs
DIS assess HI
V status &
PrEP eligibility
Slide4King County
STD Clinic PrEP Program
Focus on MSM at high risk (risk-prioritized) and Black & Latino MSM (to address inequities in access)PrEP fully integrated – all clinicians can prescribe DIS coordinate the programCounseling, payment assistance applications, HIV/STD screeningSMS-based appointment reminder and two-way text systemBaseline visit – same day PrEP prescriptionFollow-up visits every 3 mo. with DIS Clinicians only see patients at intake, then every 6 months
Slide5Evolution of PrEP Referral Process
1Katz et al. AIDS Patient Care STDs 2016; 30: 208-14. 2Katz et al. Sex Transm Dis 2016; 43: 249-54.3http://www.kingcounty.gov/healthservices/health/communicable/~/media/health/publichealth/documents/hiv/PrEP-Implementation-Guidelines.ashx. 4Katz et al. CROI 2017, Abstract 89.
ES highest risk of concurrent STI/HIV
dx1
May 2015
Assess all, Refer ES & rectal GC
Post-STI HIV incidence2DOH/PHSKC Guidelines3
Apr 2017Black & Latino MSM eligible for PH PrEP4
Practice
Evidence
Nov 2017
Improve process for trans/non-binary clients
Slide6Supplemental Database – PrEP Questions
Slide71Does not include Black/Latino MSM with no other risk; criterion added April 2017
PS Delivery & PrEP Use
7546
STI cases reported among HIV-negative MSMAug 2014 – Aug 2017
1840 (90%) had PrEP use assessed
2055 (55%) at high risk for HIV11517 early syphilis or rectal GC538 other risk
1398 (83%) had PrEP use assessed
1684 (45%) at lower risk for HIV
3739 (50%) received partner services
907
(49%) on PrEP already
951
(51%) not on PrEP
443 (31
%) on PrEP already
976
(
69
%) not on PrEP
Slide8PrEP Referral Outcomes
*Within 3 months of PS interview
Among 539 high risk MSM
with
STDs
who reported not being on
PrEP during PS interview, Jan 2016-Aug 2017
Cases53946626210886
Of offered, 18% known to have attended visit*Unable to assess external referrals
*
Slide9Facilitators and Barriers
Slide10Prospective Assessment
ObjectivesAssess effectiveness of referralsInform decision re: additional follow-up post-referralMethodsRandom sample of MSM not on PrEP from 2016 PSStratified by high/low risk and did/did not accept referral3-minute follow-up phone interview to:Asess PrEP use following PSIdentify barriers to PrEP/reasons for stoppingDetermine current interest/eligibility and offer new referralsCurrent statusDIS completed interviews Apr-Sep 2017Analyses to inform follow-up activities underway
Slide11Other Models in WA State
Slide12Summary & Conclusions
STD PS present an opportunity to promote PrEP to a large and diverse population of MSM at high risk for HIVLHJs developed unique approaches to PrEP promotion based on their context and resourcesKing County - Referring MSM to a PH clinic and community providers was successful at promoting PrEP Additional efforts needed to improve delivery and uptake at each step of referral processOngoing M&E used to improve prioritization and processPrEP promotion should be considered an outcome of STD PS for high risk populations
Slide13Acknowledgments
AAPPS Evaluation TeamTeal Bell, Matt Golden, Julie Dombrowski, Zandt BryanLocal Health JurisdictionsField services teamsKing: Dawn Spellman, Mike Barry, Christina Thibault, PrEP clinic teamSpokane: Lisa St. JohnPierce: Evelyn Manley Rodriguez, LaShawn Jones
CDC DSTDP
Brandy Maddox, Marion Carter
Funding & SupportCDC AAPPS Evaluation Supplement & Minority AIDS InitiativeWashington State DOHPublic Health – Seattle & King County