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Expanding PrEP Access by Embedding Unannounced SNAPS Navigators in High STI Testing Clinical Sites.

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The SNAPS navigation program successfully linked diverse individuals to PrEP care. However, medication possession ratios decreased post-implementation, indicating a need for improved adherence support in HIV prevention.

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Area of Science:

  • Public Health
  • HIV Prevention
  • Health Services Research

Background:

  • Pre-exposure prophylaxis (PrEP) is a critical tool for HIV prevention.
  • Integrating PrEP services with navigation and financial assistance can improve access.
  • Safety-net hospitals serve diverse, vulnerable populations requiring tailored HIV prevention strategies.

Purpose of the Study:

  • To evaluate the impact of the SNAPS (Synergistic Navigation and PrEP Services) program on PrEP care delivery and outcomes.
  • To assess adherence and retention in PrEP care among diverse patient populations.
  • To identify challenges and areas for improvement in PrEP cascade completion.

Main Methods:

  • Implementation of a co-located PrEP navigation, clinical services, and payment assistance program (SNAPS) in a NYC safety-net hospital.
  • Retrospective cohort analysis comparing pre-SNAPS and post-SNAPS patient characteristics.
  • Assessment of PrEP adherence using mean medication possession ratios (MPRs) and retention via appointment tracking over 12 months.

Main Results:

  • The post-SNAPS cohort was more diverse, with fewer cisgender men, White individuals, and English speakers compared to the pre-SNAPS cohort.
  • Mean MPR was significantly lower in the post-SNAPS cohort (0.68) compared to the pre-SNAPS cohort (0.89).
  • Cisgender men and men who have sex with men (MSM) showed higher retention in PrEP care within the post-SNAPS group compared to cisgender women.

Conclusions:

  • The SNAPS program effectively increased access to PrEP for diverse populations.
  • Lower mean MPR post-SNAPS suggests challenges in maintaining long-term adherence.
  • Sustained investment is crucial to optimize later stages of the PrEP care cascade for all populations at risk of HIV.