Primary Care and Pre-exposure Prophylaxis Services in Publicly Funded Family Planning Clinics in the Southern United States

Abstract Background Atlanta, GA ranks third in the nation for highest rates of new HIV diagnoses, disproportionally affecting Black men and women. Pre-exposure prophylaxis (PrEP) is underutilized in this population due to multiple barriers to uptake, including limited access to PrEP delivery programs. The advantages of a primary pharmacy-led PrEP program include: relatively low service fees, perform and assess point-of-care testing, and provide adherence counseling. Similar programs across the United States have been shown to effectively increase PrEP uptake and optimize retention in care. Grady Health System (GHS), the fifth largest public hospital system in the United States, is located at the epicenter of the HIV epidemic: downtown Atlanta. It encompasses 11 different primary care clinics, accounting for 850,000 outpatient visits per year. In August 2018, we launched a developmental pilot of a GHS pharmacy-based tele-PrEP program, aiming to optimize PrEP access for vulnerable populations who would otherwise not be able to obtain it. PrEP services are provided directly to the community and through a consultative support program for all clinical sites within the GHS system. The key pilot interventions included developing a user-friendly electronic medical record (EMR)-based PrEP order sets and brief provider education interventions in 6 GHS primary care clinics, to increase PrEP awareness among non-HIV clinicians. Methods We conducted a retrospective process evaluation of the pilot PrEP program based on the PrEP continuum of care. Results Over 9 months, 95 referrals were received from providers within the GHS clinics. Of the 95 patients referred, 56 (59%) started PrEP. Two patients were started on post-exposure prophylaxis prior to initiation of PrEP. Forty-five patients (81%) remain on PrEP as of April 2019. Six clients were diagnosed with 9 STIs on screening (4 syphilis, 2 gonorrhea, 2 chlamydia, 1 lymphogranuloma venereum). There have been no HIV seroconversions in patients on PrEP. Conclusion Utilizing a pharmacy-based PrEP program to train and support clinical providers in a large, hospital system can facilitate PrEP uptake and retention for patients in primary care. Disclosures All authors: No reported disclosures.

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982. Formal Education Improves Southeastern United States Primary Care Residents’ Understanding and Attitudes Towards HIV Pre-Exposure Prophylaxis: Results of a Regional Survey

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1168 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S519-S519

Author(s):

Christian D Weaver ◽

Leandro A Mena ◽

Lori M Ward

Keyword(s):

Internal Medicine ◽

United States ◽

Primary Care ◽

Nurse Practitioners ◽

Formal Education ◽

Southeastern United States ◽

Research Support ◽

Regional Survey ◽

Comfort Levels ◽

Exposure Prophylaxis

Abstract Background HIV pre-exposure prophylaxis (PrEP) has been identified as one of the pillars of the national plan to end the HIV epidemic. Notably, southern states have also been shown to have the lowest PrEP-to-need ratio in the country, and previous work on assessing clinician understanding of and attitudes towards PrEP has mainly focused on in-practice physicians, nurse practitioners, and other clinicians. We aimed to assess the attitudes towards and understanding of PrEP among residents training in programs categorized as primary care in the Southeastern United States. Methods Program directors in ACGME approved residency programs in Family Medicine, Internal Medicine, Internal Medicine-Pediatrics, and Obstetrics and Gynecology were asked to distribute an invitation with a link to the survey to their residents during a six week period in May and June 2019. The survey contained questions that assessed demographics, type of program, PrEP awareness, knowledge, attitudes, and formal education Logistic regression was utilized to assess association between formal PrEP education and comfort levels with PrEP and other STI related topics. Results We identified approximately 7,574 residents across 247 residencies in 11 states. We received 217 responses to our survey, of which 203 had complete data for analysis. The majority of the sample was 25-29 years old (75%), male (53%), White (46%), and PGY-2 (48%). Twenty-one percent of the sample received formal education on PrEP. After controlling for demographic variables, residents with prior formal PrEP education were more likely to be comfortable taking sexual history from LGBTQI patients, discussing/providing PrEP, discussing PrEP efficacy, discussing PrEP monitoring, side effects, drug resistance, and adherence compared to residents who did not have formal PrEP education (Table 1). Association Between Formal PrEP Education and Comfort Levels with Discussing PrEP and other STI Related Topics Conclusion We found a strong association between formal PrEP education and resident’s confidence in discussing PrEP. Investing in formal resident education programs in the Southern region will be important in achieving the Ending the HIV Epidemic’s goal of reducing new infections by 75% in 5 years and 90% in 10 years. Disclosures Leandro A. Mena, MD, MPH, Binx Health (Grant/Research Support)Evofem (Grant/Research Support)Gilead Science (Consultant, Grant/Research Support, Speaker’s Bureau)GSK (Grant/Research Support)Janssen (Grant/Research Support)Merck (Consultant, Grant/Research Support)Roche Molecular (Consultant, Grant/Research Support)SpeedDx (Grant/Research Support)ViiV Healthcare (Consultant, Grant/Research Support, Speaker’s Bureau)

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