Improved HIV Preexposure Prophylaxis Uptake in New York City

Preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is a highly effective tool, but it is underutilized, and significant inequities exist regarding which populations are able to access PrEP. Although most PrEP care occurs in specialty settings, such as sexual health and HIV clinics, most individuals eligible for PrEP are seen in primary care; this imbalance represents an opportunity to expand PrEP access. New York City Health and Hospitals (NYC H+H) is a municipal health care system that provides primary and specialty care across the five boroughs of New York City. To address the gap in PrEP access within primary care, a multidisciplinary working group within NYC H+H was convened in June 2023, and it included primary care providers, nursing staff, and administrative stakeholders within primary care, virology, quality, and data and analytics. The working group interfaced with facilities directly to listen to and engage with the care teams and patients to identify barriers and develop supports to facilitate implementing PrEP services within primary care. In response to care team and patient needs, electronic medical record tools were developed, and customized training and patient-facing educational materials were created to address identified gaps in care team knowledge regarding PrEP care services. Training and electronic medical record tool dissemination occurred, initially, as a proof of concept at one pilot site in East New York, Brooklyn, from June to December 2023, and resulted in a threefold increase in PrEP uptake among patients who had a documented PrEP discussion with their care team, at 20% (15/76), as compared with the NYC H+H system for PrEP uptake, at 6.8% (1207/17,724) (P<0.000). Moreover, the increase in PrEP uptake was seen across populations that traditionally face barriers to accessing PrEP. Through this patient- and care team-centered approach, PrEP care services were able to be implemented in an equitable way within a primary care clinic setting.