1299. Iowa TelePrEP: Preliminary Experience with a Public Health-Partnered, Telemedical PrEP Delivery Model in a Rural State

Abstract

Background. Access to HIV pre-exposure prophylaxis (PrEP) is often poor in small urban and rural areas due to long distances to PrEP providers and stigma. In 2017, the Iowa Department of Public Health (IDPH), University of Iowa (UI), and community representatives collaborated to develop a public health-partnered tele-medical PrEP delivery model to overcome these barriers (TelePrEP). IDPH personnel working in fve sexually transmitted infection (STI) clinics and partner services (PS) programs in Eastern Iowa screened clients for PrEP indications and referred those with need to TelePrEP pharmacist providers at UI. Via collaborative practice, pharmacists completed initial and follow-up PrEP home video visits with clients on smart phones and laptops. Clients obtained laboratory monitoring and STI screening in public health-afliated and local laboratories in accordance with USPHS/CDC guidelines, and received PrEP medication by mail. PS personnel linked TelePrEP clients with new-ly-identifed STIs to local treatment. Methods. Using the PrEP continuum as framework, we used IDPH databases and UI medical records to conduct a retrospective process evaluation of the TelePrEP model (February 2017-April 2018). Results. TelePrEP received 44 referrals from public health and 59 self-referrals via advertising. Pharmacists completed 84 initial visits (81% of referrals), including 37 visits (84%) with clients referred by public health. Most (94%) started emtricit-abine/tenofovir afer initial visits. Retention in TelePrEP at 6 months was 87%. 96% of guideline-indicated laboratory tests (HIV, creatinine, STI, hepatitis) were completed at baseline and follow-up. Rates of extragenital chlamydia and gonorrhea screening were lower (74 of 104 completed screens) due to variable availability of swabs at local laboratories. 15 clients were diagnosed with 20 STIs on screening (6 syphilis, four gonorrhea, 10 chlamydia) and one unrecognized pregnancy was identifed. PS linked all clients with STIs on screens to treatment within 14 days (80% in 3 days). Conclusion. Using telemedicine, healthcare systems can partner with public health administered STI clinics and PS programs to create virtual PrEP delivery models in rural settings. Public health partnerships enhance client identifcation and ensure linkage to care for new STI diagnoses in telemedicine programs.