PrEParing for Change: Using Quality Improvement to Provide HIV PrEP to Unhoused Youth and Young Adults

Human immunodeficiency virus (HIV) disproportionately impacts young people aged 13-24 years, particularly youth experiencing homelessness (YEH). Effective HIV pre-exposure prophylaxis (PrEP) exists, but barriers to uptake are high. The purpose of this study is to identify at-risk patients seen in a homeless shelter-associated clinic and develop a process to prescribe PrEP in-house for easier access.

The model for improvement framework was used with multiple Plan-Do-Study-Act (PDSA) cycles. These included stakeholder interviews, increasing identification of eligible patients and building community partnerships to enable prescribing to this low-resource, uninsured population.

Screening increased from 0% to 98% of YEH served by the clinic. Prior to in-house prescribing, 92% of patients were referred out with no YEH initiating PrEP. Once in-house prescribing began, 79% of all eligible and interested YEH received PrEP prescriptions.

PrEP access can be increased for at-risk YEH through increased screening and community partnerships.