- Cody Shafer: Prevention Services Coordinator, Iowa telePrEP
- Ashley Zuppelli: Innovation Services Director, Trillium Health
The goal of the Health Resources and Services Administration (HRSA) is to reduce the HIV infection rate 75 percent by 2025, and 90 percent by 2030. Speaker’s at HRSA’s webinar titled “Using Technology to Advance the Prescription of PrEP” on June 4, showcased ways in which their health care organizations are using telehealth to make a positive impact in the LGBTQ community.
HRSA’s prevention plan is split between four pillars: diagnose, treat, prevent and respond. PrEP, which stands for pre-exposure prophylaxis, addresses the pillar of prevention and is a daily medication usually taken in the form of a pill that helps stop HIV from taking hold and spreading in the body.
Although PrEP is more than 90 percent effective at preventing HIV, many other barriers may prevent those who need the medication from getting it. Cody Shafer works with the Iowa Department of Public Health Bureau of HIV, STDs and Hepatitis. According to Shafer, these barriers include geographic isolation, a shortage of providers knowledgeable about PrEP prescribing and LGBTQ issues, privacy concerns and social stigma. Shafer said before the program launched, he was seeing patients travel more than 75 miles each way for regular HIV screening and prevention services for fear that a provider or someone else would disclose this information within the patient’s local community.
Within his role at IDPH, Shafer helps launch prevention programs, which among them is the Iowa telePrEP program. The program focuses its attention on providing rural areas with access to the medication; Shafer said rural areas are often overlooked with these kinds of initiatives. Rural patients in Iowa account for 27 percent of annual HIV incidences.
“You can see based on annual HIV incidents that we do have a duty and an obligation to increase access to HIV prevention and treatment efforts in rural and largely geographically dispersed regions and in the same way we focus our resources and attention on urban areas.”
The telePrEP program focuses on leveraging community based advertising, along with PrEP screening and educating to help navigate patients to this central point of care. Partnering with IDPH and the University of Iowa health care system, the program secures access to labs for testing. These sites are close enough for patient convenience, but also distanced enough to protect patient privacy within their communities. TelePrEP uses a HIPAA-compliant platform to deliver synchronous video visits with clinical pharmacists.
The use of pharmacists allows for the service to be delivered for free and focuses on relationship building with the patient. The program also recently piloted at-home testing that allows the swab to be mailed back to the lab for quick results.
“Because of all of these things, we have been able to increase access to PrEP to individuals who cannot currently see a provider in their local area,” Shafer said. “We have been able to maintain folks in PrEP care if those folks would never access PrEP in a traditional community setting…We successfully integrated with the public health programs to ensure those that are most at risk are given choices for their prevention and access.”
Of those that were referred to their services, 42 percent opted for the telehealth model, compared to a face-to-face model. And of those that elected the telehealth model, the program saw a patient retention rate of 77 percent, compared to the national brick-and-mortar HIV program retention rate of around 60 percent.
Trillium Health is an FQHC look alike that started partnering with RHCs to furnish HIV telehealth services in 2013. Partnering with providers, Trillium Health also uses prevention navigators to help test, link and retain patients in care. This subset of the staff have similar lived experiences with the patient, which can help forge connection and trust. The model is set up to where PrEP is available 24/7 on call, so that those who may not be able to reach out during normal clinical hours, are still able to have access.
Ashley Zuppelli, who helps manage Trillium Health’s HIV telehealth program says that provider concerns in rural areas, from a clinician and patient perspective, was a major reason the program was launched.
“A lot of primary care providers may not have the bandwidth or experience or comfort level providing PrEP; this is a way to navigate these issues,” Zuppelli said.
There are a plethora of reasons this could occur. Many providers may not feel comfortable talking about managing sexual health or may not have the staffing level to support patient retention. For patients, this lack of provider knowledge can be off-putting. However, Zuppelli has seen that the telehealth program has been a gateway to primary care for some. Trillium Health is currently seeing around 1,000 patients through the program.
Besides the infrastructure, any health organization that wanted to launch a telePrEP program should anticipate other challenges such as community-specific messaging, previously exposed HIV patients, patients coming in post-sexual assault and language barriers. Having a team in place to address these issues will best serve the populations in question.
“PrEP is not the hard part here,” Zuppelli said. “It is making sure that people have everything they need to retain care.”