PrEP implementation by local health departments in US cities and counties: Findings from a 2015 assessment of local health departments

PLOS ONE, Nov 2019

Objective The United States Public Health Service released clinical practice guidelines for daily oral preexposure prophylaxis (PrEP) in May 2014. Local health departments (LHDs) are expected to play a critical role in PrEP implementation. We surveyed LHDs to assess awareness of and interest in supporting PrEP implementation, what roles they were taking, or believed they should take, in supporting PrEP, and what resources would be required to do so. Methods LHDs were surveyed in 2015 to assess their engagement in PrEP implementation (n = 500). The study employed a cross-sectional survey design with a randomly selected stratified sample. Results Among responding LHDs (n = 284), 109 (29%, weighted proportion) reported engagement in PrEP implementation. LHDs serving large jurisdictions (population 500,000+) and located in the West were more likely to be engaged in PrEP implementation. Making referrals for PrEP (74%) and conducting education and outreach to community members (51%) were the activities most frequently reported by LHDs engaged in PrEP implementation; 45% anticipated expanding their level of engagement. Among LHDs not engaged in PrEP implementation, 13% expected to become engaged over the next four years, 46% were undecided, and 41% reported it was unlikely. Information about PrEP for health care providers and information about PrEP for health department staff were the most frequently reported resource needs for LHDs engaged and not engaged in PrEP implementation, respectively. Conclusions PrEP implementation by LHDs was limited in 2015, three years after Food and Drug Administration approval and one year after the U.S. Public Health Service issued clinical practice guidelines. PrEP is a recently available intervention that is requiring LHDs to adjust existing HIV prevention efforts and service delivery models. Additional resources and implementation research is needed to effectively support PrEP scale-up by LHDs. Efforts must also be undertaken to increase PrEP awareness, knowledge, and implementation capacity among LHDs.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0200338&type=printable

PrEP implementation by local health departments in US cities and counties: Findings from a 2015 assessment of local health departments

July PrEP implementation by local health departments in US cities and counties: Findings from a 2015 assessment of local health departments Gretchen Weiss 0 1 Dawn K. Smith 1 Sarah Newman 0 1 Jeffrey Wiener 1 Alyssa Kitlas 0 1 Karen W. Hoover 1 0 National Association of County and City Health Officials, Washington, District of Columbia, United States of America, 2 Division of HIV/AIDS Prevention, National Center for HIV/AIDS , Viral Hepatitis, STD, and TB Prevention , Centers for Disease Control and Prevention , Atlanta, Georgia , United States of America 1 Editor: Javier R. Lama, Asociacion Civil Impacta Salud y Educacion , PERU The United States Public Health Service released clinical practice guidelines for daily oral preexposure prophylaxis (PrEP) in May 2014. Local health departments (LHDs) are expected to play a critical role in PrEP implementation. We surveyed LHDs to assess awareness of and interest in supporting PrEP implementation, what roles they were taking, or believed they should take, in supporting PrEP, and what resources would be required to do so. LHDs were surveyed in 2015 to assess their engagement in PrEP implementation (n = 500). The study employed a cross-sectional survey design with a randomly selected stratified sample. Among responding LHDs (n = 284), 109 (29%, weighted proportion) reported engagement in PrEP implementation. LHDs serving large jurisdictions (population 500,000+) and located in the West were more likely to be engaged in PrEP implementation. Making referrals for PrEP (74%) and conducting education and outreach to community members (51%) were the activities most frequently reported by LHDs engaged in PrEP implementation; 45% anticipated expanding their level of engagement. Among LHDs not engaged in PrEP implementation, 13% expected to become engaged over the next four years, 46% were undecided, and 41% reported it was unlikely. Information about PrEP for health care providers and information about PrEP for health department staff were the most frequently reported resource needs for LHDs engaged and not engaged in PrEP implementation, respectively. - Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: Funding for this research was provided by the Centers for Disease Control and Prevention (https://www.cdc.gov/) via Award Number 5U38OT000172-02-REVISED. The efforts of GW, SN, and AK were supported by the Centers for Disease Control and Prevention via Award Number 5U38OT000172-02-REVISED. The funder Objective Methods Results ☯ These authors contributed equally to this work. ³ These authors also contributed equally to this work. * participated in study design, data analysis, decision to publish, and preparation of the manuscript. Conclusions PrEP implementation by LHDs was limited in 2015, three years after Food and Drug Administration approval and one year after the U.S. Public Health Service issued clinical practice guidelines. PrEP is a recently available intervention that is requiring LHDs to adjust existing HIV prevention efforts and service delivery models. Additional resources and implementation research is needed to effectively support PrEP scale-up by LHDs. Efforts must also be undertaken to increase PrEP awareness, knowledge, and implementation capacity among LHDs. Introduction Goal 1 of the National HIV/AIDS Strategy for the United States (U.S.): Updated to 2020 (NHAS 2020) is to reduce by 25% the number of new HIV infections diagnosed in the U.S. in 2020 compared to the number diagnosed in 2010 [1]. To achieve this goal, the NHAS 2020 includes a call for clinical and public health organizations to provide full access to daily oral antiretroviral preexposure prophylaxis (PrEP) services to those for whom it is appropriate. It is now well established, based on the results from several large clinical trials and open label studies, that PrEP with daily doses of co-formulated tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg)±marketed in the U.S. with the brand name Truvada by Gilead Sciences, Foster City, California±is safe and highly effective for HIV prevention. With high medication adherence, PrEP can reduce the risk of HIV acquisition by >90% among those with sexual exposure risk and >70% among those with injection risk. The U.S. Food and Drug Administration (FDA) has approved an HIV prevention indication for Truvada, and the Centers for Disease Control and Prevention (CDC) has published clinical practice guidelines for PrEP use, to reduce the risk for acquiring HIV infection among gay, bisexual and other men who have sex with men (MSM), heterosexually active women and men (HET), and persons who inject drugs (PWID) with specific behavioral and clinical indications [2]. CDC estimates that 1.2 million Americans without HIV infection currently engage in sexual or drug use behaviors that place them at ongoing substantial risk of acquiring HIV infection, and so would benefi (...truncated)


This is a preview of a remote PDF: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0200338&type=printable

Gretchen Weiss, Dawn K. Smith, Sarah Newman, Jeffrey Wiener, Alyssa Kitlas, Karen W. Hoover. PrEP implementation by local health departments in US cities and counties: Findings from a 2015 assessment of local health departments, PLOS ONE, 2018, Volume 13, Issue 7, DOI: 10.1371/journal.pone.0200338