1. Lowering Barriers to Engage Hard to Find Communities in PrEP
Merge Ahead! Steering HIV Prevention into the new landscape February 2016
data through 31 March 2015
Jessica Horwitz FNP-C, AAHIVS
Alfonso LaCorte CCMA, CPT

2. CRUSH/PREP Cohort Overview
Context/Background
CRUSH overview
Addressing Barriers to accessing PrEP
Lessons Learned
CRUSH/PREP Cohort Overview

3. Why a sexual health clinic for young MSM? What would the model be?
New cases are increasing among MSM, and in particular African Americans young MSM/MSM of color
MSM between made up 81% of new cases between in AC
ACA/Covered CA meant push to get younger people enrolled in health service
NO municipal/public supported STI clinic in Alameda County
New HIV cases appear to be increasing among MSM, and decreasing among heterosexuals": -Heterosexuals make of 18.9% of all PLWH at the end of 2012, and 9.8% of new HIV infections between MSM made up 64.9% of all PLWH at the end of 2012; they made up 73.2% of all new HIV cases between "The epidemic has disproportionate impact on African American and Latino MSM" -AA and Latino MSM 53% of MSM living with HIV in Alameda County (including MSM who inject drugs)-AA are 34.9%; Latinos 18% -Of ALL new cases : African American MSM 36.9% and Latino 22.9% "The youth epidemic is being driven in large part by increase in new infections among MSM of color" --MSM between the ages of made up 81.4% of ALL new cases between Among young PLWH (18-29), persons of color make up 86.8% of all PLWH at the end of % of all new diagnosed cases are between year olds between
Why a sexual health clinic for young MSM? What would the model be?

4. EBAC and Downtown Youth Center
East Bay AIDS Center…..Downtown Youth Clinic (1997)
HIV primary care center, psychosocial, and peer treatment based services for HIV + youth (13-29 yrs)
“Clinic without walls”: Linkage and retention, TAKEN TO clients- at their homes, at other agency sites; clinic cellphones and communicate with clients via text messaging
Enhanced access: Flexible drop in provider availability; non punitive if missed appointments;
Approx. 220 HIV Positive youth <29
Over 80 % MSM
70% virally suppressed
EBAC and Downtown Youth Center

5. Establishing a Model Sexual Health Clinic: CRUSH PROJECT
California HIV/AIDS Research Project: Epidemiological Interventions Initiative (EII)
Novel approaches to addressing the HIV prevention care and treatment continuum (PrEP-TLC +)
Funded April 2013, 4 years, 3 sites in CA: multi- million state wide investment
Goal of CRUSH:
To integrate routine sexual health services for Y/MSM within the setting of an existing HIV primary care clinic (including the provision of PrEP)
Establishing a Model Sexual Health Clinic: CRUSH PROJECT

6. HIV Negative Cohort First participant enrolled on 2-10-2014
FINAL DATA
First participant enrolled on
Last participant enrolled on
281 total participants
177 currently enrolled
66 have completed follow up
21 are past 12 months and lost to follow-up
17 discontinued before 12 months
To be completed
HIV Negative Cohort

7. Who is choosing PrEP? Ethnicity Referral Source
FINAL DATA
Ethnicity
Referral Source
Maybe add referral source
Who is choosing PrEP?
252 individuals, predominantly male. Age: 24.7 ± 2.9

8. Barriers to Accessing PrEP
NO municipal/public supported STI clinic in Alameda County
Lack of insurance and primary care services
Transportation
Primary care providers lack of experience and comfort prescribing PrEP
What is sexual health?! Prevention vs Treatment
Shame and stigma
Barriers to Accessing PrEP

9. Reducing Barriers to PrEP Access
Open door clinic without strict appointment times
Retention Coordinator
Patient Navigation: warm handoffs
Benefits Counselor
Patient Assistance Program navigation
Sex positive clinical environment – from start to finish
Reducing Barriers to PrEP Access

10. PrEP Retention and Adherence Support
PrEP Navigation & Retention Coordinator:
First point of contact, patient navigator, back up test counselor
Peer support
Weekly review of missed visits, medication pick up’s
Text reminders for up coming visits, questions
Visit navigation and warm hand-offs
PrEP Retention and Adherence Support

11. Accessing PrEP Benefits Counselor
Insurance
Explanation of current benefits and out-of-pocket costs
Patient Assistance Program navigation
Co-Pay Card
PEP Access
Patient Assistance for those without health insurance
Accessing PrEP

12. Lessons Learned: integrating Sexual Health/PrEP initiatives
Clinical:
10% at baseline seeking PrEP actually need PEP:
Solidify warm hand-off for primary care services for HIV negatives
Administrative:
Cross-training staff: HIV testing, intake, consent, lab processing, referrals
Administrative challenges working within a hospital system
Developing & documenting clinical flow is crucial & ever changing
Strengthening intra-agency collaboration ultimately helps with clinic flow
Developing assessment tools for clinical and program staff to address the PrEP to PEP interplay
Increased STI treatment 3 fold: Nurses were like “WHAT????”

13. Lessons Learned Community:
Establishing a robust Community Advisory Board
Discussion with partners “What does sexual health mean? What are the outreach messages for Y/MSM?”
Your patients are your strongest referral site- good and bad
Lessons Learned

14. Acknowledgements:
Our Funder: CHRP
The CRUSH and DYC Team at EBAC
Our UCSF/CAPS Evaluation Team
Our CAB and community partners