Use of nursing staff, PrEP navigators, and telehealth were linked to increased enrollment and retention rates of patients at risk for HIV. Reducing barriers to sexually transmitted infection (STI) screenings can serve as a step toward providing more patients pre-exposure prophylaxis (PrEP) to prevent the spread of HIV, according to research presented by Gabriela Brito, MSN, RN, ACRN, and Cheryl Netherly, BSW, LPN, ACLPN, at the Association of Nurses in AIDS Care (ANAC) annual meeting held November 17 to 19, 2022, in Tampa, Florida.
The intervention was conducted at 22 CAN Community Health locations and was designed to engage more patients at risk for HIV in PrEP services and maintain adherence over time. CAN Community Health is a nonprofit organization that provides free STI testing and uses these opportunities to link high-risk patients to PrEP services. A key component of the intervention was the use of nursing staff to initiate treatment and PrEP navigators to encourage treatment adherence.
The researchers analyzed electronic medical record data to calculate how many patients who received free STI testing were subsequently provided PrEP. “We wanted to look at the number of people that come in for our free testing services and then those people who actually end up transferring over to PrEP services,” said Netherly, who is a clinical educator and support manager for CAN Community Health in Sarasota, Florida. The goal was to differentiate factors associated with linkage to care and barriers to care.
As of September 30, 2022, 32% (n=696) of 2174 patients receiving PrEP services were initially seen by CAN Community Health Prevention and Education Staff for free STI testing. The majority of patients receiving PrEP services (n=1478) heard about CAN Community Health’s PrEP services through other means, including word of mouth and internet searches.
Brito and Netherly noted that nurses play a key role in linking patients who receive STI testing to PrEP services and are currently working to increase PrEP uptake at CAN clinics.
Intervention Increased PrEP Retention Rates
The intervention increased PrEP retention rates at 6 months by nearly 20%, from 44% in January 2022 to 61% in September 2022. Increasing retention rates became a matter of breaking down barriers to accessing care, according to Brito and Netherly. Working with a PrEP navigator was a key strategy for increasing retention rates, according to the researchers. Of the 2174 patients taking PrEP, 63% (n=1377) have been assigned and continue to work with a PrEP navigator. The team does not require that a patient work with a navigator, but they highly encourage them.
The researchers identified a number of reasons that patients may stop taking PrEP including when they enter monogamous relationships or stop sexual activity. Other factors that may be linked to lack of adherence include viewing PrEP appointments as inconvenient and not worth the trouble of traveling to the clinic.
“We meet people where they are and by linking them directly to navigators who are overseeing them one on one and keeping track of their appointments,” said Brito, who is registered nurse team lead. Navigators may ask “what can we do to facilitate you to actually make it into the clinic? Can we provide transportation?”
Also, CAN Community Health has continued to offer telehealth appointments as well as the ability to complete laboratory testing at either a CAN facility or an outside laboratory. “We have young professionals who work, who can’t take off in the middle of the day to go to the doctor,” Netherly said. “But what should we do? Well, let’s do telehealth. Can you do telehealth on your lunch break from your car?”
“PrEP is a very integral component of actually eradicating the HIV epidemic, which is our main goal,” Brito said.
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Brito G, Netherly C. From STI screening to PrEP: crucial linkages leading the path towards ending the HIV epidemic. Presented at: ANAC2022; November 17-19, 2022; Tampa, FL.