Family Planning Provider PrEP Toolkit
PrEP (pre-exposure prophylaxis) for HIV prevention is highly effective and safe. PrEP works for women. The CDC estimates 176,670 U.S. women could benefit from PrEP. However, fewer Black women have been prescribed PrEP?or know about PrEP than white women.
Forty percent of women access reproductive health care only, making family planning clinics a logical and efficient location for offering PrEP to women. Family planning providers are uniquely skilled to offer options within a shared decision making model. Women want to hear about PrEP from family planning providers. Prevention of sexually transmitted infections, including HIV, is a core part of providing quality family planning services.
PrEP services have been successfully implemented in a variety of family planning settings and in different ways. Even as additional training and infrastructure support are needed to fully implement PrEP in the family planning setting, PrEP clinic champions as well as PrEP user champions are emerging.
While this toolkit is focused on cisgender women, we understand that people of all genders and sexual preferences (including gay and bisexual men) receive care in family planning settings.
This Family Planning Provider PrEP Toolkit aims to support PrEP implementation based on existing tools and resources.
To access resources in the toolkit, please click on the plus sign in each of the banners below.
Are you a PrEP clinic champion? Would you like to be one? A PrEP clinic champion can lead the way to implement the necessary clinical and administrative protocols for smooth PrEP delivery. You can opt to offer PrEP in your clinic, or, if you are not ready or unable to provide PrEP, develop a strong referral network with local PrEP providers. You don?t have to do this alone!
Training for being a PrEP champion is available at no cost from:
- National Capacity Building Assistance Provider Network (free technical assistance)
- National Clinical Training Center for Family Planning (free technical assistance)
- National Clinician PrEPline (free clinical telephone consultation)
There are also networks of PrEP champions out there who can help! Learning about supporting user demand and integrating consumer feedback can make your job easier. Check out the following resources to find people and ideas:
- HIVE Blog
- Facebook groups (you must be logged in to Facebook and request to join the groups):
–PrEP Facts for Women
- Learn more here: Decision-Making Guide for the Provision of PrEP Services in Title X-Funded Family Planning Service Sites
Talking About HIV and PrEP
HIV prevention counseling is best provided early and often. People who are getting HIV and STI tests are ideal candidates for HIV prevention messaging. Consider adding brief questions like: ?Did you know that there is a new HIV prevention method called PrEP? It?s a pill that you can take every day if you are HIV negative to prevent HIV.? This brief counseling can be done by a peer navigator, medical assistant, nurse, physician assistant or doctor. Consider also a shared decision-making approach which focuses on women?s values and preferences ? a way forward for supporting women as they balance competing priorities.
Before prescribing PrEP, a point-of-care or laboratory-based HIV test is required (CDC discourages using the oral fluid test for HIV screening in PrEP use) as well as ruling out acute HIV if there is a recent exposure. Many family planning clinics routinely provide HIV testing.
Resources on HIV testing are available from:
- CDC?s HIV testing guidance
- Guidance for Delivering HIV Pre-Test and Post-Test Counseling: Integrating HIV Screening Into Title X Services
- Clinical Consultation Center Warmline: Free telephone consultation service on all aspects of HIV
- Webinar: HIV Testing Technologies in the Title X Context
Providers at family planning clinics can easily integrate PrEP prescribing in to their practice. These providers can also serve as valued sources of information for women. Resources on PrEP prescribing and developing provider networks are below.
- Expert consultation is available Monday to Friday, 11a.m.-6p.m. ET to walk you through the process of prescribing PrEP.
- Not ready to prescribe? Develop your own active handoff referral process with a local PrEP provider.
- AltaMed video on PrEP prescribing
PrEP Follow-up and Adherence
After a PrEP prescription has been filled, the next steps are follow-up and adherence. Quarterly follow up visits include STI testing, renal labs, and counseling around daily pill taking. If you do not have capacity at your clinic to do follow-up and adherence counseling, consider being a screening and prescribing site and developing an “active handoff” protocol to a local provider.
Reimbursement (medical visit/s, tests, medication)
Developing reimbursement mechanisms and coverage for patient costs is an important part of a PrEP program?s sustainability plan.
Resources and tools to support the development of local and site-specific reimbursement plans are below.
- CDC?s Paying for PrEP
- NASTAD?s HIV Prevention Billing Code Guide
- Family Planning National Training Centers Maximizing Third Party Reimbursement for HIV Testing: Integrating HIV Screening Into Title X Services
- HIV testing cost calculator
- Truvada for PrEP Medication Access Guide
- Online chat navigation available via PleasePrEPMe.org
Ancillary staff can support providers in the provision of PrEP. For example, a benefits or PrEP navigator can help in high-volume clinics to assure medication coverage, lab costs and paperwork are in order. Pharmacists can play an important role in working with the Gilead Medication Assistance Program. Another option for eligible clinics is to consider 340B pricing and medication reimbursement as a sustainability model.
Patient-specific reimbursement resources are available.
Developing a clinic flow for serving potential PrEP patients as well as longitudinal follow up includes staff at every level.
Resources to support PrEP programs at all levels within a clinic include:
- Staff roles and responsibilities can be tailored to your clinic?s resources and needs
- Health departments may have resources to support PrEP and associated costs and/or navigation services.
- Electronic medical records can provide opportunities to operationalize screening for PrEP as well as follow up visits.
- Quality assurance measures related to PrEP should be integrated into the clinic?s evaluation plan.
- Finally, consider providing patient resources with a mindful approach, tailored to clinic populations including language, reading level, and images: women-centered patient PrEP resources.
There are distinct populations at risk for HIV who may benefit from PrEP, including pregnant and postpartum women, gay and bisexual men, youth, transgender persons, people who inject drugs, and people who exchange sex for drugs, money, or shelter. PrEP implementation for distinct populations is emerging. Some current resources for working with these distinct populations include:
- Preconception, pregnant or breastfeeding women may benefit from PrEP. Any pregnant woman prescribed an antiretroviral should be added to the Antiretroviral Pregnancy Registry. Provider job aids for PrEP during pregnancy and breastfeeding can be found here. Resources for women can be found here.
- More information on PrEP use during pregnancy and/or breastfeeding, can be found in this brochure.
- Call the Perinatal HIV Hotline number for help with PrEP in preconception, pregnant, or breastfeeding women
- Adolescents: Sexuality Information and Education Council of the United States (SIECUS)?s PrEP Education for Youth Serving Primary Care Providers Toolkit
- Transgender men and women
*As specific tools for people who are substance involved or people who exchange sex are developed, we will add them here.
Toward Health Equity
We know that health equity means striving for the best possible standard of health for all people. Yet, Black women in the U.S. are 20 times more likely to acquire HIV than White women and have a 1 in 52 lifetime risk of acquiring HIV. Additionally, fewer Black women have been prescribed pre-exposure prophylaxis (PrEP) for HIV prevention or know about PrEP than white women. Black women face striking disparities in a wide range of women?s health outcomes and report feeling uncomfortable and judged in conversations with healthcare providers about their sexual health.
Striving for health equity requires a closer look at the root causes of disparities. In the United States, structural racism has contributed to inequities in housing, education, employment, media representation, healthcare access & services, criminal justice and more. It is essential to contextualize racialized health disparities as a structural failing, not an individual problem.
To learn more about addressing disparities and preventing HIV acquisition among all women, check out HIVE’s Health Equity Page. Also check out: PrEP4Love and Black Women?s Health Imperative?s #LetsTalkAboutPrEP.
This toolkit was created in part with support from?Jonathan Fuchs, MD, MPH, getsfcba at the Center for Learning & Innovation, San Francisco Department of Public Health, and Jacki Witt, University of Missouri-Kansas City, School of Nursing and Health Studies getsfcba. For more information, please click here: http://getsfcba.org/