Laying the Foundation for PrEP in Urgent Care Settings
Matt Gravett, M.D.
University of Alabama at Birmingham
The primary goal of this study is to better understand if it is acceptable for urgent care clinics to start HIV pre-exposure prophylaxis (PrEP) for people who may need it. PrEP is the term used to describe HIV medication that is taken by people who do NOT have HIV to prevent them from acquiring HIV. It is very effective at preventing HIV, and it is very safe. There are three different medications that can be used for PrEP (two oral pills and one shot), but they all work similarly. For this study, it does not matter about the kind of PrEP used, since this study is focused on just starting PrEP in the urgent care clinic and not the medication itself.
HIV is a major health concern in the Deep South. In the United States, over half of all new HIV diagnoses occur in the South each year. Among these new diagnoses, Black and Latino people are eight times more likely to be diagnosed than White people. PrEP is one way to help stop new HIV diagnoses, but the people who need PrEP the most do not get PrEP as much as is needed. Black and Latino men who have sex with men (MSM), transgender women of color, and Black, cisgender women in the South access PrEP are much lower rates when compared to White people or when compared to other regions of the country. PrEP is becoming increasingly common knowledge, especially among MSM, but that does not mean that these persons are using PrEP. Some of the reasons that these persons do not access PrEP include lack of knowledge about PrEP or lack of understanding their own HIV risk, unable to find a provider to prescribe PrEP, not having transportation to the provider, competing priorities such as jobs or childcare, and fear about someone finding out about them seeking PrEP. It is also important to note that structural racism, stigma, and homophobia also strongly contribute to this.
People who need PrEP should have health care options for getting PrEP. Urgent care clinics (UCC) are clinics that see walk-in patients to take care of a wide range of needs (sports physicals, medication refills, common colds, etc.). Testing and treatment for sexually transmitted infections (STIs) are also a common reason for going to the urgent care clinics. Urgent care clinics test for STIs and often test for HIV, but urgent care clinics do not prescribe PrEP or refer to a PrEP provider in most cases. Many people who go to urgent care clinics for STIs are often at risk for HIV, so it would be important them to be able to get PrEP to reduce their chances of acquiring HIV. To better understand how PrEP could fit into the urgent care setting, this study will look at the acceptance of incorporating PrEP into urgent care by asking urgent care clinic staff and urgent care clinic patients how they feel about it. The question for this work is whether the patients and the staff will find it acceptable to start PrEP in the UCC setting.
