1. Integrating PrEP into STD Partner Services in Washington State
David Katz, PhD MPH
University of Washington
Public Health – Seattle & King County
NCSD Engage
November 16, 2017

2. STD Partner Services (PS) in Washington State
STD PS present an opportunity to provide population-based HIV prevention to people at high risk
In 2012, WA State began integrating interventions across HIV prevention/care continuum
PrEP referral
HIV testing
HIV/STI testing reminders
Engagement in HIV care
Simultaneously prioritized MSM for PS
MSM account for >2/3 of HIV infections in WA
Facilitated by gender of sex partners on case report

3. King County PS Program & PrEP Referrals
DIS attempt to provide partner services to MSM w/ STIs
DIS assess HIV status &
PrEP eligibility
HIV-negative MSM at high risk1
early syphilis or rectal GC
methamphetamine or poppers use
sex work
HIV-unsuppressed partner
Black or Latino
HIV-negative MSM at lower risk
CT or urethral/pharyngeal GC without behavioral risk
Offer referral to PrEP at public health STD clinic or community providers
Offer referral to community providers for PrEP
1http://

4. King County STD Clinic PrEP Program
Focus on MSM at high risk (risk-prioritized) and Black & Latino MSM (to address inequities in access)
PrEP fully integrated – all clinicians can prescribe
DIS coordinate the program
Counseling, payment assistance applications, HIV/STD screening
SMS-based appointment reminder and two-way text system
Baseline visit – same day PrEP prescription
Follow-up visits every 3 mo. with DIS
Clinicians only see patients at intake, then every 6 months

5. Evolution of PrEP Referral Process
Oct 2014
Assess & refer ES to PrEP
Rectal GC highest risk of future HIV2
Jan 2016
Refer all, Stratified by risk
Black/Latino <PrEP than white MSM4
Practice
May 2015
Assess all, Refer ES & rectal GC
Apr 2017
Black & Latino MSM eligible for PH PrEP4
Nov 2017
Improve process for trans/non- binary clients
Evidence
ES highest risk of concurrent STI/HIV dx1
Post-STI HIV incidence2
DOH/PHSKC Guidelines3
1Katz et al. AIDS Patient Care STDs 2016; 30: Katz et al. Sex Transm Dis 2016; 43: http:// 4Katz et al. CROI 2017, Abstract 89.

6. Supplemental Database – PrEP Questions

7. PS Delivery & PrEP Use 7546 STI cases reported among HIV-negative MSM
Aug 2014 – Aug 2017
3739 (50%) received partner services
2055 (55%) at high risk for HIV1
1517 early syphilis or rectal GC
538 other risk
1684 (45%) at lower risk for HIV
1840 (90%) had PrEP use assessed
1398 (83%) had PrEP use assessed
907 (49%) on PrEP already
951 (51%) not on PrEP
443 (31%) on PrEP already
976 (69%) not on PrEP
1Does not include Black/Latino MSM with no other risk; criterion added April 2017

8. PrEP Referral Outcomes
Among 539 high risk MSM with STDs
who reported not being on PrEP during PS interview, Jan 2016-Aug 2017
Of offered, 18% known to have attended visit*
Unable to assess external referrals *
Cases
539
466
262
108 86
*Within 3 months of PS interview

9. Facilitators and Barriers
Gender of sex partners on case report
Dedicated DIS
Existing supplemental database
PH PrEP clinic
Availability of PrEP in community
State drug assistance program
Barriers
Recorded in separate database
Balancing standard PS activities vs PrEP
Navigating insurance, assistance program

10. Prospective Assessment
Objectives
Assess effectiveness of referrals
Inform decision re: additional follow-up post-referral
Methods
Random sample of MSM not on PrEP from 2016 PS
Stratified by high/low risk and did/did not accept referral
3-minute follow-up phone interview to:
Asess PrEP use following PS
Identify barriers to PrEP/reasons for stopping
Determine current interest/eligibility and offer new referrals
Current status
DIS completed interviews Apr-Sep 2017
Analyses to inform follow-up activities underway

11. Other Models in WA State
Pierce Co.
DIS refer to 1 provider group
Appointing privileges
EMR access
ROI to share records
PH offers quarterly labs
DIS follow-up with patients who do not schedule or attend appointments
Spokane
DIS refer to PH navigators for persons at high risk for HIV (PAHR)
PrEP education, referral, & adherence support
Insurance & care linkage
Other social/medical needs
Refer to and support community providers

12. Summary & Conclusions
STD PS present an opportunity to promote PrEP to a large and diverse population of MSM at high risk for HIV
LHJs developed unique approaches to PrEP promotion based on their context and resources
King County - Referring MSM to a PH clinic and community providers was successful at promoting PrEP
Additional efforts needed to improve delivery and uptake at each step of referral process
Ongoing M&E used to improve prioritization and process
PrEP promotion should be considered an outcome of STD PS for high risk populations

13. Acknowledgments CDC DSTDP AAPPS Evaluation Team Funding & Support
Teal Bell, Matt Golden, Julie Dombrowski, Zandt Bryan
Local Health Jurisdictions
Field services teams
King: Dawn Spellman, Mike Barry, Christina Thibault, PrEP clinic team
Spokane: Lisa St. John
Pierce: Evelyn Manley Rodriguez, LaShawn Jones
CDC DSTDP
Brandy Maddox, Marion Carter
Funding & Support
CDC AAPPS Evaluation Supplement & Minority AIDS Initiative
Washington State DOH
Public Health – Seattle & King County