HIV Pre-Exposure Prophylaxis (PrEP) uptake is slower in the Southern US and may be limited by structural barriers such as lack of healthcare access. For marginalized populations, county health departments may be important PrEP access points; however, there are little data on successful PrEP programs at these venues outside of incentivized demonstration projects. We implemented an open-access, free PrEP clinic at a county health department in Atlanta, GA and describe early PrEP uptake and persistence estimates.
The Fulton County Board of Health (FCBOH) PrEP clinic launched in October 2015, and eligible clients who expressed interest initiated PrEP and attended follow-up visits per CDC guidelines. FCBOH covered all costs associated with provider visits and PrEP lab monitoring; clients used their health insurance and/or manufacturer assistance program to obtain the drug. Clients engaged in quarterly follow-up and seen within the last 6 months were defined as ‘persistent’, whereas clients with a lapse in follow-up of ≥ 6 months were defined as ‘not persistent.’ Factors associated with PrEP persistence were assessed with unadjusted odds ratios.
Between October 2015 and March 2017, 373 clients were screened for PrEP eligibility in accordance with CDC guidelines. Almost all were eligible [367/373 (98%)]; however, 151/367 (41%) did not return to start PrEP after screening. Over half [216/367 (59%)] of PrEP eligible clients attended an enrollment visit, and 201/216 (76%) received a prescription for PrEP. Of 201 clients who started PrEP, 88% were male, 65% were black, 72% were men who have sex with men, 78% reported inconsistent condom use, and 80% had a prior sexually transmitted infection. As of March 2017, only 78/201 (39%) clients remained persistent in PrEP care, and the only evaluated factor significantly associated with PrEP persistence was lack of health insurance (OR 2.68, 95% CI 1.38, 5.36; Table 1). Among persistent clients who have started PrEP, there have been no HIV seroconversions thus far.
Implementation of PrEP in the county health department setting is feasible and appears to be an effective strategy to reach key populations in need of HIV prevention services. However, we have identified significant challenges with PrEP uptake and persistence in our setting. Further research is needed to fully understand mediators of PrEP persistence and inform interventions to optimize health department-based PrEP services.