MedicalResearch.com Interview with:
Paul M. Salcuni, MPH
Department of Health and Mental Hygiene
New York City
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: NYC Health Department is committed to ensuring equitable access to HIV pre-exposure prophylaxis (PrEP) for all New Yorkers who are HIV-negative and may be exposed to HIV. We examined trends in PrEP prescribing by 602 ambulatory care practices in New York City from 2014 to 2016, as well as associated patient and practice factors, to inform our comprehensive scale-up efforts. For every 100,000 medical visits in the first three months of 2014, roughly 39 involved a patient being prescribed PrEP. In the second quarter of 2016, 419 of every 100,000 medical visits at those same practices involved a PrEP prescription.
Despite this nine-fold increase overall, some groups of patients among these practices were less likely to be prescribed PrEP. Those groups include men of color, women, and people getting health care at smaller private practices or practices outside of the city center.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Data from this sample of New York City practices suggest that PrEP prescription is increasing. Between 2014 and 2016, we saw a nine-fold increase in prescribing PrEP among a sample of 600 clinics. However, PrEP prescribing appears to differ across multiple factors. For example, men and patients who were white appeared more likely to receive a PrEP prescription. Practices in Manhattan appeared more likely to prescribe than those in other locations in New York City. These results should be interpreted with caution, given that this sample does not include some key clinical practices in New York City known to reach the underserved and/or prescribe PrEP, nor does the sample include NYC Health Department’s eight Sexual Health Clinics. However, the trends shown here justify the need for programs that ensure equitable access to PrEP for men of color, for women, and for people with inadequate access to services in/near the city center.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Since these data come from a select sample of New York City practices, it is important to continue developing strategies for tracking PrEP prescriptions across the city. Leveraging and triangulating other data sources is key to building a more comprehensive understanding of PrEP utilization. Further, additional research is needed to develop effective, culturally responsive services, programming, and outreach strategies to address disparities in PrEP awareness and uptake, with focus on women and men of color.
MedicalResearch.com: Is there anything else you would like to add?
Response: NYC Health Department has been vigilant in monitoring and preemptively acting on disparities in PrEP use and prescribing. In January 2014, we launched a PrEP and post-exposure prophylaxis (PEP) detailing campaign to provide primary care and infectious disease practices with resources to support PrEP and PEP. Providers receive one-on-one education visits using a NYC Health Department-developed PrEP and PEP Action Kit. To date, the campaign has visited over 2,500 providers at over 1,300 clinical sites across the city. In order to have the greatest impact, we visited providers at sites which had recently diagnosed HIV in men of color who have sex with men, who are disproportionately affected by HIV in New York City. We prioritize practices located in high-poverty neighborhoods, independent practices, and primary care providers, who have been shown in other studies to be less comfortable prescribing PrEP compared to infectious disease specialists, despite their unique position to identify potential patients.
In order to better address the limited awareness and utilization of PrEP among women, NYC Health Department is currently planning to launch a new PrEP and PEP detailing campaign focusing on women’s health providers in order to address the disparity in prescribing by gender.
We also have promoted PEP and PrEP awareness the through our “Be Sure, Play Sure, Stay Sure” sexual health media campaigns, which encourage New Yorkers to know their HIV and STI statuses, choose the safer sex combination that works for them, and take medications to help treat or prevent HIV. “Stay Sure,” our most recent campaign, promotes HIV prevention services in New York City, including the consistent use PrEP, access to PEP, and condoms while encouraging New Yorkers living with HIV to stay on treatment to stay healthy and prevent transmitting HIV to others.
In 2016, NYC Health Department launched the PlaySure Network, a network of clinical and nonclinical providers working together to ensure that all New Yorkers have access to services, including HIV testing, HIV treatment, PrEP, and PEP. Members work collaboratively to increase access to PrEP and PEP for people (especially those without insurance) who may be exposed to HIV – including gay and bisexual men, transgender people, and people who have a partner living with HIV.
Investment in our local Sexual Health Clinics, formerly known as STD Clinics, has allowed us to reestablish them as destination hubs of sexual health care accessible to all New Yorkers. In February 2017, NYC Health Commissioner Dr. Mary T. Bassett announced the historic expansion of HIV and STI services at our eight Clinics, including additional staff, expanded hours, and renovations. Currently, all eight sites offer the following low- to no-cost services to minor and adult patients: HIV and STI testing; STI treatment; a complete course of PEP for HIV-negative persons who may have been exposed to HIV; PrEP navigation services, including PrEP initiation at five Clinics. Seven Clinics offer JumpstART, which provides immediate antiretroviral treatment and connection to care for eligible patients newly diagnosed with HIV. Patient navigation services and behavioral health services are also available at all Clinics.
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Trends and Associations with PrEP Prescription among 602 New York City (NYC) Ambulatory Care Practices, 2014-16
Paul Salcuni, MPH ; Jenny Smolen, MPH ; Sachin Jain, MD ; Julie Myers, MD, MPH ; Zoe Edelstein, PhD, MS
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