In 2010, the National HIV/AIDS Strategy outlined a comprehensive plan to combat the HIV/AIDS epidemic. One of the tools included to halt the spread of the virus to uninfected persons was pre-exposure prophylaxis, known commonly as PrEP. PrEP is a once-a-day regimen, currently consisting of the drug Truvada, to help HIV-negative adults at substantial risk of acquiring HIV to prevent infection.
To make the national strategy actionable, the U.S. Centers for Disease Control and Prevention (CDC) released clinical guidelines in 2014 that provide support for integrating PrEP into high-quality care settings. When these guidelines were first introduced, primary care physicians were relatively unaware of how to incorporate PrEP into their practice as most HIV care was, and still is, provided by specialists.
Primary care providers are, however, the front line of care for patients at risk of contracting HIV, and therefore must be able and willing to identify those who would benefit from PrEP. The traditional 15 minute office visit and the current fee-for-service reimbursement structure are not designed for the in-depth discussion necessary to identify those at highest risk and to determine if a particular person is a good candidate for PrEP.
With the support of a grant from the CDC, the Primary Care Development Corporation now helps providers increase their HIV prevention capacity and translate these guidelines into practice. PCDC’s trainers have developed training and materials designed to help primary care practitioners overcome barriers to HIV testing and screening, such as time restrictions and general stigma, understand which patients would benefit most from PrEP, and learn best practices to engage patients in prevention. PCDC provides hands-on assistance to practices, health centers, and health systems to integrate these services at all levels of care.
Interventions such as PrEP in the primary care setting, along with readily accessible testing and effective treatment, may finally be the key to ending the spread of HIV.
PCDC’s HIP in Health Care team offers free trainings to assist providers looking to integrate PrEP. Contact the HIP team for more information.
Primary care providers interested in integrating PrEP into their services are encouraged to read and become familiar with the CDC PrEP guidelines. Additional, state-specific information may be available through the provider’s state health department. For help and suggestions from peers, providers can find a provider who is already using PrEP.
About the author:
Sarah Blust, LMSW, MPH, Program Director
Phone: 212-437-3955Email: firstname.lastname@example.org Sarah Blust, Program Director, leads PCDC’s CDC-funded HIV prevention capacity-building assistance program and manages large-scale training and technical assistance projects that support the delivery of HIV prevention services within primary care and health care organizations. With 20 years of experience in the health care field, Sarah has worked in clinical settings as a direct service provider and program manager and now provides training and consultation to health care organizations across the country to support their delivery, operations and infrastructure. Her training and technical assistance experience covers a variety of areas such as HIV/AIDS, women’s health, reproductive health, cultural competency, motivational interviewing, mental health, behavioral health, patient navigation, care coordination, quality improvement, and the use of evidence-based interventions. While at PCDC, Sarah co-authored the nationally recognized Care Coordination Fundamentals course created in partnership with 1199SEIU and co-led a national HIV training and technical assistance project as part of the HRSA-funded National Center for HIV Care in Minority Communities. Prior to PCDC, she served as Program Manager for MIC Women’s Health Services, a program of Public Health Solutions and provided HIV testing and reproductive health counseling at Planned Parenthood of NYC. As a licensed social worker, Sarah worked for over five years as a therapist for children and families within the Administration for Children’s Services (ACS) system. Sarah received her bachelor’s degree from Oberlin College, and her masters’ degrees from Columbia University.