Implementation of a PrEP program for HIV prophylaxis at the STD clinic: a collaboration between the City of Portland Public Health Division and Maine Medical Center

Background: The India Street Public Health Center Sexually Transmitted Diseases (STD) Clinic is housed within the City of Portland Public Health Division and aims to provide low barrier, low cost services to clients who may not otherwise utilize the healthcare system. The clinic is staffed with city outreach and disease intervention specialists, and is run in partnership with clinical staff from Maine Medical Center including a preventive medicine physician, pharmacist, and trainees. Many clinic clients are candidates for HIV prophylaxis with pre-exposure prophylaxis (PrEP). PrEP is a highly effective preventive tool, but globally many people who would benefit are not currently taking PrEP. In October 2017, the STD clinic started offering a PrEP program including prescriptions, providing support around payment options, and low barrier follow up. This analysis aims to describe patients who receive PrEP at the STD Clinic. Methods: Using clinic medical records from October 2017 through November 2019, we identified patients who received a prescription for PrEP. Prescription information was extracted from a password-protected Excel spreadsheet and subsequent patient demographic information was extracted from patient intake forms that are stored in a secure, HIPAA-compliant REDCap database. Data analysis was conducted using a password-protected Excel database and STATA/IC. Results: A total of 141 patients enrolled in India Street Public Health Center\u27s PrEP program; 80.9% of those who initiated PrEP were seen for a follow up appointment. 96% (n=135) of participants identified as males, 34% (n=48) were uninsured. At the time of enrollment, 38% (n=54) did not have primary care providers (PCPs); 26% (n=14) were subsequently linked to community PCPs. Conclusions: A PrEP program implemented at an STD clinic was able to reach a population with otherwise limited preventive care access. This demonstrates how a public private collaboration can provide PrEP and also serve an access point for linkage to primary care