1299. Iowa TelePrEP: Preliminary Experience with a Public Health-Partnered, Telemedical PrEP Delivery Model in a Rural State
Session: Poster Abstract Session: HIV: Prevention
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • 1299 Iowa TelePrEP Poster.pdf (385.4 kB)
  • Background: Access to HIV pre-exposure prophylaxis (PrEP) is often poor in small urban and rural areas due to long distances to PrEP providers and stigma. In 2017, the Iowa Department of Public Health (IDPH), University of Iowa (UI), and community representatives collaborated to develop a public health-partnered telemedical PrEP delivery model to overcome these barriers (TelePrEP). IDPH personnel working in 5 sexually transmitted infection (STI) clinics and partner services (PS) programs in Eastern Iowa screened clients for PrEP indications and referred those with need to TelePrEP pharmacist providers at UI. Via collaborative practice, pharmacists completed initial and follow up PrEP home video visits with clients on smart phones and laptops. Clients obtained lab monitoring and STI screening in public health-affiliated and local labs in accordance with USPHS/CDC guidelines, and received PrEP medication by mail. PS personnel linked TelePrEP clients with newly-identified STIs to local treatment.

    Methods: Using the PrEP continuum as framework, we used IDPH databases and UI medical records to conduct a retrospective process evaluation of the TelePrEP model (Feb 2017-Apr 2018).

    Results: TelePrEP received 44 referrals from public health and 59 self-referrals via advertising. Pharmacists completed 84 initial visits (81% of referrals), including 37 visits (84%) with clients referred by public health. Most (94%) started emtricitabine/tenofovir after initial visits. Retention in TelePrEP at 6 months was 87%. 96% of guideline-indicated lab tests (HIV, creatinine, STI, hepatitis) were completed at baseline and follow up. Rates of extragenital chlamydia and gonorrhea screening were lower (74 of 104 completed screens) due to variable availability of swabs at local labs. 15 clients were diagnosed with 20 STIs on screening (6 syphilis, 4 gonorrhea, 10 chlamydia) and one unrecognized pregnancy was identified. PS linked all clients with STIs on screens to treatment within 14 days (80% in 3 days).

    Conclusion: Using telemedicine, healthcare systems can partner with public health administered STI clinics and PS programs to create virtual PrEP delivery models in rural settings. Public health partnerships enhance client identification and ensure linkage to care for new STI diagnoses in telemedicine programs.

    Angela Hoth, PharmD MPH1, Cody Shafer, EIS/PrEP Coordinator2, Dena Dillon, PharmD AAHIVP3, Constanza Scheetz, Health Educator4, Seth Owens, Health Educator4, Kathryn Edel, Health Educator4 and Michael Ohl, MD MSPH5, (1)Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Health Care, Iowa City, IA, (2)Bureau of HIV, STD, and Hepatitis, Iowa Department of Public Health, Des Moines, IA, (3)Pharmaceutical Care, University of Iowa Department of Pharmaceutical Care, Iowa City, IA, (4)Johnson County Public Health Department, Iowa City, IA, (5)Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA

    Disclosures:

    A. Hoth, Gilead Sciences, Inc: Research team member , Research support .

    C. Shafer, None

    D. Dillon, None

    C. Scheetz, None

    S. Owens, None

    K. Edel, None

    M. Ohl, Gilead Sciences, Inc: Grant Investigator , Research grant .

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