HIV PrEP implementation in an integrated behavioral health in primary care setting

Purpose of Project: PrEP decreases a person's chances of contracting HIV by more than 92%. PrEP is a crucial intervention in the Ending the HIV Epidemic Initiative; however, implementation has been slow in communities affected by HIV (Chan, Seiler, & Chu, 2020). Increase HIV prevention services in one month by initiating a standardized PrEP implementation protocol. Improve staff screening of patients who qualify for PrEP and provide a PrEP cascade, per CDC guidelines, for implementing PrEP after identifying at-risk patients. Promote provider ability to identify, manage, and counsel patients by providing a standardized protocol on implementing PrEP. Methodology: The project used a mixed-method design to assess quantitative/qualitative data in integrated behavioral health in a primary care setting located in an urban city. The sample included a chart review and interview of providers at the clinic. Chart review used fifty Charts of patients18 years or older who presented at the clinic one month before and one month after initiating the protocol without an existing HIV/AIDS diagnosis. The interviews were a convenience sampling of the providers at the integrated behavioral health service in the primary care clinic. The chart review analysis used descriptive statistics and paired statistical tests compared the data for the two sets of outcomes (number of PrEP prescriptions written and HIV risk factors. The structured phone interviews measured providers’ perspectives regarding implementation of the protocol in everyday practice through using the grounded theory approach. Results: The objective of creating a standard PrEP implementation protocol was achieved. PrEP prescriptions by 33%, but the goal to increase the assessed HIV risk behaviors by 25% was not met. The chart review did not provide statistically significant results, but the results identified the need for future research and interventions in this field. The interviews assessed the PrEP training’s effectiveness, but only half of the clinic providers agreed to participate in the interviews. The clinic no longer includes the behavioral health component and incorporated a primary care model during the implementation process of the project. The providers discussed that the policy served as a reminder for HIV screening daily practice and broadened their view of candidates for PrEP. Interviews found that the policy could encourage more providers to offer PrEP and was effective in organizing the process of PrEP follow-up. The providers identified that continued barriers include patient ambivalence about taking PrEP, “lifestyle changes,” high no show rates, lack of provider familiarity and confidence to prescribe PrEP, Insurance coverage, the deficit in providers time, and building trust. Implications for Practice: Clinical practice implications indicated that even when a standardized policy is in place a clinic still faces implementation barriers such as (1) providers’ lack of confidence in PrEP prescription, (2) failure to integrate the full team in care, (3) concerns about PrEP follow-up care. Health care providers must identify policies affecting PrEP implementation and address the state-level social policies that affect how PrEP is implemented and viewed. Future research indicated in PrEP telehealth and the development of validated highly accurate risk assessment tools for identifying people at high risk of HIV. Continuous education recommended for providers, clinical staff, and students on HIV prevention practices. Case management telehealth to address economic concerns with follow-up. Advocate for future policies and laws reducing the medication cost of PrEPDNPIncludes bibliographical reference