Skip to main content

Advertisement

SpringerLink
Log in

PrEP Implementation and Persistence in a County Health Department Setting in Atlanta, GA

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

For marginalized populations, county health departments may be important PrEP access points; however, there are little data on successful PrEP programs at these venues outside of incentivized demonstration projects. Therefore, we implemented an open-access, free PrEP clinic at a county health department in Atlanta, GA to promote PrEP uptake among high-risk clients. The Fulton County Board of Health PrEP clinic launched in October 2015, and eligible clients who expressed interest initiated PrEP and attended follow-up visits per CDC guidelines. Clients engaged in quarterly follow-up and seen within the last 6 months were defined as “persistent”, whereas clients with a lapse in follow-up of > 6 months were defined as “not persistent.” Factors associated with PrEP persistence were assessed with unadjusted odds ratios. Between October 2015 and June 2017, 399 clients were screened for PrEP, almost all were eligible [392/399 (98%)]; however, 158/392 (40%) did not return to start PrEP after screening. Of 234 patients, 216 (92%) received a prescription for PrEP. As of June 2017, only 69/216 (32%) clients remained persistent in PrEP care, and the only evaluated factor significantly associated with PrEP persistence was age ≥ 30 years (OR 1.86, 95% CI 1.02, 3.42). Implementation of PrEP in the county health department setting is feasible; however, we have identified significant challenges with PrEP uptake and persistence in our setting. Further research is needed to fully understand mediators of PrEP persistence and inform interventions to optimize health department-based PrEP services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention. HIV surveillance report, 2016, vol 28. http://www.cdc.gov/hiv/library/reports/surveillance/ (Nov 2017). Accessed 15 June 2018.

  2. AIDSVu. www.aidsvu.org. Emory University, Rollins School of Public Health. https://aidsvu.org/state/georgia/atlanta/. Accessed 9 Jan 2017.

  3. Hess KL, et al. Lifetime risk of a diagnosis of HIV infection in the United States. Ann Epidemiol. 2017;27(4):238–43.

    Article  PubMed  PubMed Central  Google Scholar 

  4. United States Public Health Service. Pre-exposure prophylaxis for the prevention of HIV infection in the United States—2014: a clinical practice guideline. http://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf. Accessed 12 Dec 2016.

  5. Kelley CF, et al. Applying a PrEP continuum of care for men who have sex with men in Atlanta, Georgia. Clin Infect Dis. 2015;61(10):1590–7.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Rendina HJ, et al. Distinguishing hypothetical willingness from behavioral intentions to initiate HIV pre-exposure prophylaxis (PrEP): findings from a large cohort of gay and bisexual men in the US. Soc Sci Med. 2017;172:115–23.

    Article  PubMed  Google Scholar 

  7. Arnold T, et al. Social, structural, behavioral and clinical factors influencing retention in pre-exposure prophylaxis (PrEP) care in Mississippi. PLoS ONE. 2017;12(2):e0172354.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Hoots BE, et al. Willingness to take, use of, and indications for pre-exposure prophylaxis among men who have sex with men-20 US cities, 2014. Clin Infect Dis. 2016;63(5):672–7.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kuehn B. PrEP disparities. JAMA. 2018;320(22):2304.

    PubMed  Google Scholar 

  10. Siegler AJ, et al. The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis-to-need ratio in the fourth quarter of 2017, United States. Ann Epidemiol. 2018;28(12):841–9.

    Article  PubMed  Google Scholar 

  11. Huang YA, et al. HIV preexposure prophylaxis, by race and ethnicity—United States, 2014–2016. MMWR Morb Mortal Wkly Rep. 2018;67(41):1147–50.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Siegler AJ, et al. Location location location: an exploration of disparities in access to publicly listed pre-exposure prophylaxis clinics in the United States. Ann Epidemiol. 2018;28(12):858–64.

    Article  PubMed  Google Scholar 

  13. Ojikutu BO, et al. Spatial access and willingness to use pre-exposure prophylaxis among Black/African American individuals in the United States: cross-sectional survey. JMIR Public Health Surveill. 2019;5(1):e12405.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rolle CP, et al. Challenges in translating PrEP interest into uptake in an observational study of young black MSM. J Acquir Immune Defic Syndr. 2017;76(3):250–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rusie LK, et al. PrEP initiation and retention in care over five years, 2012-2017: are quarterly visits too much? Clin Infect Dis. 2018;67:283–7.

    Article  PubMed  Google Scholar 

  16. Doblecki-Lewis S, et al. Patterns and correlates of participant retention in a multi-city pre-exposure prophylaxis demonstration project. J Acquir Immune Defic Syndr. 2018;79:62–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Chan PA, et al. Retention in care outcomes for HIV pre-exposure prophylaxis implementation programmes among men who have sex with men in three US cities. J Int AIDS Soc. 2016;19(1):20903.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hojilla JC, et al. HIV pre-exposure prophylaxis (PrEP) uptake and retention among men who have sex with men in a community-based sexual health clinic. AIDS Behav. 2018;22(4):1096–9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Grinsztejn B, et al. Retention, engagement, and adherence to pre-exposure prophylaxis for men who have sex with men and transgender women in PrEP Brasil: 48 week results of a demonstration study. Lancet HIV. 2018;5(3):e136–45.

    Article  PubMed  Google Scholar 

  20. Huang YA, Tao G, Smith DK, Hoover KW. Persistence with HIV preexposure prophylaxis in the United States, 2012-2016. In: Conference on retroviruses and opportunistic infections, March 4–7, 2019, Seattle, WA, Abstract 106.

  21. Coy KC, et al. Persistence on HIV preexposure prophylaxis medication over a 2-year period among a national sample of 7148 PrEP users, United States, 2015 to 2017. J Int AIDS Soc. 2019;22(2):e25252.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Serota DP, Rosenberg ES, Thorne AL, del Rio C, Luisi N, et al. PrEP persistence and discontinuation in a Cohort of young black men who have sex with men in Atlanta, GA. In: Conference on retroviruses and opportunistic infections (CROI), March 4–7, 2019, Seattle, WA, Abstract 963.

  23. White House Office of National AIDS Policy. National HIV/AIDS strategy for the United States updated to 2020 (2015).

  24. Weiss G, et al. PrEP implementation by local health departments in US cities and counties: findings from a 2015 assessment of local health departments. PLoS ONE. 2018;13(7):e0200338.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Nunn AS, et al. Defining the HIV pre-exposure prophylaxis care continuum. AIDS. 2017;31(5):731–4.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Liu AY, et al. Preexposure prophylaxis for HIV infection integrated with municipal- and community-based sexual health services. JAMA Intern Med. 2016;176(1):75–84.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Marcus JL, et al. Preexposure prophylaxis for HIV prevention in a large integrated health care system: adherence, renal safety, and discontinuation. J Acquir Immune Defic Syndr. 2016;73(5):540–6.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Centers for Disease Control and Prevention. Social determinants of health and selected HIV care outcomes among adults with diagnosed HIV infection in 32 states and the District of Columbia, 2014. HIV Surveill Suppl Rep. 2016;21(7):1–62.

    Google Scholar 

  29. Blackstock OJ, et al. Pre-exposure prophylaxis prescribing and retention in care among heterosexual women at a community-based comprehensive sexual health clinic. AIDS Care. 2017;29(7):866–9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hosek S, et al. An HIV pre-exposure prophylaxis (PrEP) demonstration project and safety study for young MSM. J Acquir Immune Defic Syndr. 2017;74(1):21–9.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Sullivan PS, et al. Implementation strategies to increase PrEP uptake in the South. Curr HIV/AIDS Rep. 2019;16:259–69.

    Article  PubMed  Google Scholar 

  32. Siegler AJ, Brock JB, Kelley CF, Ahlschlager LA, Rolle CPM, et al. Pilot test of a PrEP telmedicine system for young black MSM in the rural US South. In: Conference of retroviruses and opportunistic infections (CROI), March 4–7, 2019, Seatlle, WA, Abstract 955.

  33. Marcus JL, et al. Disparities in uptake of HIV preexposure prophylaxis in a large integrated health care system. Am J Public Health. 2016;106(10):e2–3.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Jenness S, Maloney K, Smith DK, Hoover KW, Goodreau SM, Weiss K, Rosenberg ES, Sullivan PS. The PrEP care continuum and HIV racial disparities among men who have sex with men. In: Conference on retroviruses and opportunistic infections (CROI), March 4–7, 2018, Boston, MA, Abstract 1149.

  35. Giler Mera R, Magnuson D, Trevor H, Bush S, Rawlings K, McCallister S. Changes in truvada (TVD) for HIV pre-exposure prophylaxis (PrEP) utilization in the United States: (2012-2016). In: 19th IAS conference on HIV science, 23–26 July 2017, Paris, France, Abstract 1614.

  36. Sheth AN, Rolle CP, Gandhi M. HIV pre-exposure prophylaxis for women. J Virus Erad. 2016;2(3):149–55.

    PubMed  PubMed Central  Google Scholar 

  37. Flash CA, et al. Perspectives on HIV prevention among urban black women: a potential role for HIV pre-exposure prophylaxis. AIDS Patient Care STDS. 2014;28(12):635–42.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Hong JN, Farel CE, Rahangdale L. Pharmacologic prevention of human immunodeficiency virus in women: practical approaches for the obstetrician and gynecologist. Obstet Gynecol Surv. 2015;70(4):284–90.

    Article  PubMed  Google Scholar 

  39. Doblecki-Lewis S, et al. HIV risk and awareness and interest in pre-exposure and post-exposure prophylaxis among sheltered women in Miami. Int J STD AIDS. 2016;27(10):873–81.

    Article  PubMed  Google Scholar 

  40. Auerbach JD, et al. Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. AIDS Patient Care STDS. 2015;29(2):102–10.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank Diakima Thomas, and the FCBOH PrEP clinic staff for their contributions and feedback.

Funding

This work was supported by the National Institutes of Health: K23AI108335 (PI: Kelley) and K23AI114407 (PI: Sheth)

Author information

Authors and Affiliations

  1. Orlando Immunology Center, 1707 North Mills Avenue, Orlando, 32803, FL, USA

    Charlotte-Paige Rolle

  2. Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Charlotte-Paige Rolle

  3. Fulton County Board of Health, Atlanta, GA, USA

    Udodirim Onwubiko & David P. Holland

  4. Emory University School of Medicine, Atlanta, GA, USA

    Jennifer Jo

  5. Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA

    Anandi N. Sheth, Colleen F. Kelley & David P. Holland

  6. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Colleen F. Kelley

Authors
  1. Charlotte-Paige Rolle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Udodirim Onwubiko
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jennifer Jo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anandi N. Sheth
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Colleen F. Kelley
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David P. Holland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charlotte-Paige Rolle.

Ethics declarations

Conflicts of interest

There are no conflicts of interest or financial disclosures for any author.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rolle, CP., Onwubiko, U., Jo, J. et al. PrEP Implementation and Persistence in a County Health Department Setting in Atlanta, GA. AIDS Behav 23 (Suppl 3), 296–303 (2019). https://doi.org/10.1007/s10461-019-02654-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-019-02654-x

Keywords

Search

Navigation