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1274. The PrEP Care Continuum Among an Uninsured Patient Population
BACKGROUND: Despite the clear preventive benefits of HIV Pre-Exposure Prophylaxis (PrEP), uptake among populations at highest risk of HIV acquisition has been limited by lack of health insurance and access to care. In March 2018 we opened a free PrEP clinic for those without insurance. We provide HI...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808867/ http://dx.doi.org/10.1093/ofid/ofz360.1137 |
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author | Jones, Trahern Wallace De La Cruz, Cinthya N Spivak, Adam Keeshin, Susana |
author_facet | Jones, Trahern Wallace De La Cruz, Cinthya N Spivak, Adam Keeshin, Susana |
author_sort | Jones, Trahern Wallace |
collection | PubMed |
description | BACKGROUND: Despite the clear preventive benefits of HIV Pre-Exposure Prophylaxis (PrEP), uptake among populations at highest risk of HIV acquisition has been limited by lack of health insurance and access to care. In March 2018 we opened a free PrEP clinic for those without insurance. We provide HIV prevention services, following the CDC guidelines, with PrEP case manager navigation, medical management, and medication for at-risk individuals free of charge. METHODS: Half-day clinics were organized on a twice-monthly basis with supervision provided by two infectious disease specialists and several other licensed providers/fellows, with supporting case managers and medical assistants. Medical students were enlisted to help organize and manage patient visits. All patient visits were preceded by discussion with case managers to document insurance status, followed by a sexual history and general physical examination by medical students and supervisory licensed providers. We performed all laboratory testing, diagnostics, and follow-up visits per CDC guidelines. RESULTS: From March 2018 to 2019, 193 self-identified at-risk patients scheduled an appointment; 157 unique patients were seen and all deemed eligible for PrEP per CDC guidelines. Of those eligible for PrEP, 140 (89%) received a prescription and started emtricitabine/tenofovir and 115 (73%) remain in care with ≥2 visits completed. Of the 25 no longer in care at our clinic, 6 have insurance or Medicaid (2 continue to be seen in our insured PrEP Clinic), 1 reports no HIV risk factors, and 1 is over-income for pharmacy patient assistance. Patients enrolled in clinic are largely male (145, 92%); 74% age ≤ 34, a disproportionate fraction belonging to a minority racial/ethnic group (67, 43%), with a majority Latinx (60, 38%). A total of 48 STI cases were identified, mostly rectal chlamydia, rectal and pharyngeal gonorrhea 39 (81%), and 9 (19%) cases of syphilis, and no new HIV or HCV infections. At the first visit, 17% of our patients have an STI and at subsequent visits 22% have a new STI. CONCLUSION: Implementation of a free PrEP clinic for uninsured patients is a feasible and effective strategy to reach key populations at risk for HIV. STI rates are high in our population and increased after starting PrEP. [Image: see text] [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures. |
format | Online Article Text |
id | pubmed-6808867 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-68088672019-10-28 1274. The PrEP Care Continuum Among an Uninsured Patient Population Jones, Trahern Wallace De La Cruz, Cinthya N Spivak, Adam Keeshin, Susana Open Forum Infect Dis Abstracts BACKGROUND: Despite the clear preventive benefits of HIV Pre-Exposure Prophylaxis (PrEP), uptake among populations at highest risk of HIV acquisition has been limited by lack of health insurance and access to care. In March 2018 we opened a free PrEP clinic for those without insurance. We provide HIV prevention services, following the CDC guidelines, with PrEP case manager navigation, medical management, and medication for at-risk individuals free of charge. METHODS: Half-day clinics were organized on a twice-monthly basis with supervision provided by two infectious disease specialists and several other licensed providers/fellows, with supporting case managers and medical assistants. Medical students were enlisted to help organize and manage patient visits. All patient visits were preceded by discussion with case managers to document insurance status, followed by a sexual history and general physical examination by medical students and supervisory licensed providers. We performed all laboratory testing, diagnostics, and follow-up visits per CDC guidelines. RESULTS: From March 2018 to 2019, 193 self-identified at-risk patients scheduled an appointment; 157 unique patients were seen and all deemed eligible for PrEP per CDC guidelines. Of those eligible for PrEP, 140 (89%) received a prescription and started emtricitabine/tenofovir and 115 (73%) remain in care with ≥2 visits completed. Of the 25 no longer in care at our clinic, 6 have insurance or Medicaid (2 continue to be seen in our insured PrEP Clinic), 1 reports no HIV risk factors, and 1 is over-income for pharmacy patient assistance. Patients enrolled in clinic are largely male (145, 92%); 74% age ≤ 34, a disproportionate fraction belonging to a minority racial/ethnic group (67, 43%), with a majority Latinx (60, 38%). A total of 48 STI cases were identified, mostly rectal chlamydia, rectal and pharyngeal gonorrhea 39 (81%), and 9 (19%) cases of syphilis, and no new HIV or HCV infections. At the first visit, 17% of our patients have an STI and at subsequent visits 22% have a new STI. CONCLUSION: Implementation of a free PrEP clinic for uninsured patients is a feasible and effective strategy to reach key populations at risk for HIV. STI rates are high in our population and increased after starting PrEP. [Image: see text] [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6808867/ http://dx.doi.org/10.1093/ofid/ofz360.1137 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Jones, Trahern Wallace De La Cruz, Cinthya N Spivak, Adam Keeshin, Susana 1274. The PrEP Care Continuum Among an Uninsured Patient Population |
title | 1274. The PrEP Care Continuum Among an Uninsured Patient Population |
title_full | 1274. The PrEP Care Continuum Among an Uninsured Patient Population |
title_fullStr | 1274. The PrEP Care Continuum Among an Uninsured Patient Population |
title_full_unstemmed | 1274. The PrEP Care Continuum Among an Uninsured Patient Population |
title_short | 1274. The PrEP Care Continuum Among an Uninsured Patient Population |
title_sort | 1274. the prep care continuum among an uninsured patient population |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808867/ http://dx.doi.org/10.1093/ofid/ofz360.1137 |
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