PrEP implementation by local health departments in US cities and counties: Findings from a 2015 assessment of local health departments

Gretchen Weiss; Dawn K Smith; Sarah Newman; Jeffrey Wiener; Alyssa Kitlas; Karen W Hoover

doi:10.1371/journal.pone.0200338

PrEP implementation by local health departments in US cities and counties: Findings from a 2015 assessment of local health departments

PLoS One. 2018 Jul 25;13(7):e0200338. doi: 10.1371/journal.pone.0200338. eCollection 2018.

Authors

Gretchen Weiss¹, Dawn K Smith², Sarah Newman¹, Jeffrey Wiener², Alyssa Kitlas¹, Karen W Hoover²

Affiliations

¹ National Association of County and City Health Officials, Washington, District of Columbia, United States of America.
² Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.

Abstract

Objective: The United States Public Health Service released clinical practice guidelines for daily oral preexposure prophylaxis (PrEP) in May 2014. Local health departments (LHDs) are expected to play a critical role in PrEP implementation. We surveyed LHDs to assess awareness of and interest in supporting PrEP implementation, what roles they were taking, or believed they should take, in supporting PrEP, and what resources would be required to do so.

Methods: LHDs were surveyed in 2015 to assess their engagement in PrEP implementation (n = 500). The study employed a cross-sectional survey design with a randomly selected stratified sample.

Results: Among responding LHDs (n = 284), 109 (29%, weighted proportion) reported engagement in PrEP implementation. LHDs serving large jurisdictions (population 500,000+) and located in the West were more likely to be engaged in PrEP implementation. Making referrals for PrEP (74%) and conducting education and outreach to community members (51%) were the activities most frequently reported by LHDs engaged in PrEP implementation; 45% anticipated expanding their level of engagement. Among LHDs not engaged in PrEP implementation, 13% expected to become engaged over the next four years, 46% were undecided, and 41% reported it was unlikely. Information about PrEP for health care providers and information about PrEP for health department staff were the most frequently reported resource needs for LHDs engaged and not engaged in PrEP implementation, respectively.

Conclusions: PrEP implementation by LHDs was limited in 2015, three years after Food and Drug Administration approval and one year after the U.S. Public Health Service issued clinical practice guidelines. PrEP is a recently available intervention that is requiring LHDs to adjust existing HIV prevention efforts and service delivery models. Additional resources and implementation research is needed to effectively support PrEP scale-up by LHDs. Efforts must also be undertaken to increase PrEP awareness, knowledge, and implementation capacity among LHDs.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Administration, Oral
Anti-HIV Agents / administration & dosage*
Cities
Cross-Sectional Studies
HIV Infections / prevention & control*
Health Knowledge, Attitudes, Practice
Health Plan Implementation*
Health Resources
Local Government
Pre-Exposure Prophylaxis* / methods
Stakeholder Participation
United States

Substances

Anti-HIV Agents

Grants and funding

Funding for this research was provided by the Centers for Disease Control and Prevention (https://www.cdc.gov/) via Award Number 5U38OT000172-02-REVISED. The efforts of GW, SN, and AK were supported by the Centers for Disease Control and Prevention via Award Number 5U38OT000172-02-REVISED. The funder participated in study design, data analysis, decision to publish, and preparation of the manuscript.