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Office of Population Affairs (OPA) releases tools to support PrEP implementation in Title X clinics

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, and 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. Early surveys of family planning providers identified training as a desired way to increase knowledge and skills to support PrEP provision.  In recent years, leaders across the U.S. have collaborated to develop clinically sound and widely-available tools to increase provide knowledge and support implementation of PrEP by family planning providers.

OPA recently published the Decision-Making Guide for the Provision of PrEP Services, a new resource to help Title X family planning service sites make evidence-informed decisions about their role in assuring access to PrEP for HIV prevention services in their communities. The development of this guide involved a thorough analysis of peer-reviewed literature on PrEP implementation, key informant interviews with family planning clinic administrators, and the convening of a Technical Expert Panel. While developed to inform PrEP decision-making in Title X-funded organizations, it may also be applicable for other settings where family planning services are offered.

The guide describes the key decision-making factors for PrEP services: 1) PrEP Programs and Partnerships involves assessing existing programs and organizational partners in the service area. 2) Service Capacity involves examining capacity for offering PrEP services based on the site’s unique structural and functional qualities. 3) Staff Readiness involves identifying and understanding the level of readiness among leadership, clinicians and staff. 4) Cost Assessment involves understanding the cost of PrEP services for the client and the site.

The Decision-Making Guide is accompanied by an organizational assessment tool to help Title X sites determine the appropriate level of PrEP service provision for their site, by considering their current level of PrEP service provision, if any, and the resources required to provide a level of service that assures access to PrEP services in their communities.

The CDC approved Family Planning Provider PrEP Toolkit (a collaboration between HIVE, San Francisco DPH Center for Learning and Innovation (CBA), National CBA Provider Network Resource Center, National Clinical Training Center for Family Planning) aims to support PrEP implementation based on existing tools and resources. The toolkit includes tips on eligibility, reimbursement, clinic flow, roles, and many other nuts and bolts –what you need to know to operationalize PrEP.The toolkit encourages conversation and learning. It encourages relationship building and shared decision-making as a best practice for conversations with patients. Given the profound health disparities among women related to both HIV acquisition and uptake of PrEP, a compendium of resources was created to support clinic staff in examining change at the individual, program and systems-level: Toward Health Equity: Addressing Racial and Ethnic Disparities in HIV.

Family planning visits are busy clinical encounters that address multiple health priorities in limited time. Integrating a new service into this environment can feel daunting, particularly when PrEP provision may require navigation for clients who are under or uninsured, and more frequent lab testing and follow-up than other family planning services. Even screening for HIV vulnerability can seem an overwhelming task, given that there are no validated questions that accurately assess a woman’s HIV risk in the U.S. In addition to structural challenges, providers and clinic staff require training on both medical provision of PrEP (which while not overly complicated, requires familiarity), and in counseling on a variety of HIV prevention options. While many family planning providers agree that PrEP provision is in their scope of practice, they want more training. “Quick starting” contraception is similar to the concept of “same day PrEP”. In both, we need to be reasonably sure that the person isn’t pregnant/has HIV, and then take advantage of the fact that the person made it to clinic today and wants to get started on a prevention method.

On a recent webinar, PrEP for HIV Prevention in Title X Funded Family Planning Sites, hosted by the Family Planning National Training Center, both tools to support the implementation of PrEP in family planning clinics were shared. This webinar was first in a series focused on supporting Title X clinics in implementing PrEP. Check out the Family Planning National Training Center website for additional webinars and resources.

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