Improved HIV Preexposure Prophylaxis Uptake in New York City

Area of Science:

• Public Health
• Infectious Disease Prevention
• Healthcare Systems Implementation

Background:

• Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool but faces underutilization and access inequities.
• Most eligible individuals receive care in primary settings, yet PrEP services are concentrated in specialty clinics.
• New York City Health and Hospitals (NYC H+H) identified a gap in primary care PrEP access.

Purpose of the Study:

• To address the underutilization and inequities in PrEP access within primary care settings.
• To develop and implement a patient- and care team-centered model for PrEP service delivery.
• To evaluate the impact of implementing PrEP services in a primary care setting.

Main Methods:

• A multidisciplinary working group convened to identify barriers and develop supports for PrEP implementation.
• Electronic medical record tools, customized training, and patient educational materials were developed.
• A pilot program was conducted from June to December 2023 at one primary care site in East New York, Brooklyn.

Main Results:

• PrEP uptake increased threefold among patients with a documented PrEP discussion (20%) compared to the system average (6.8%).
• The increase in PrEP uptake was observed across populations traditionally facing access barriers.
• The patient- and care team-centered approach facilitated equitable implementation of PrEP services.

Conclusions:

• Integrating PrEP services into primary care can significantly increase uptake and improve equitable access.
• A collaborative, needs-based approach involving care teams and patients is effective for implementing new clinical services.
• This model demonstrates a successful strategy for expanding HIV prevention services within large urban healthcare systems.