HIV Preexposure Prophylaxis Service Delivery Models for Emergency Departments: A Qualitative Study
Background Oral preexposure prophylaxis (PrEP) effectively prevents HIV but is underutilized in the United States, particularly among populations with higher incidence of HIV. Emergency departments (EDs), which often care for medically underserved individuals, could play a key role in expanding PrEP...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2025-05-01
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| Series: | Journal of the International Association of Providers of AIDS Care |
| Online Access: | https://doi.org/10.1177/23259582251342842 |
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| author | Ethan Cowan MD, MS Susie Hoffman DrPH Laurie J Bauman PhD Yvette Calderon MD, MS Tatiana Gonzalez-Argoti BS Christine T Rael PhD Jonathan Porter MPH Joanne E Mantell MS, MSPH, PhD |
| author_facet | Ethan Cowan MD, MS Susie Hoffman DrPH Laurie J Bauman PhD Yvette Calderon MD, MS Tatiana Gonzalez-Argoti BS Christine T Rael PhD Jonathan Porter MPH Joanne E Mantell MS, MSPH, PhD |
| author_sort | Ethan Cowan MD, MS |
| collection | DOAJ |
| description | Background Oral preexposure prophylaxis (PrEP) effectively prevents HIV but is underutilized in the United States, particularly among populations with higher incidence of HIV. Emergency departments (EDs), which often care for medically underserved individuals, could play a key role in expanding PrEP access. However, integrating PrEP into ED workflows presents challenges. Methods This qualitative study involved interviews with 22 stakeholders from 15 EDs and 4 sexual health clinics across the United States. Participants included ED leaders, providers, and navigators. The data were analyzed using a PrEP care cascade model, focusing on provider buy-in, patient identification, education, PrEP initiation, and linkage to care. Results Key barriers included limited provider knowledge, ED priorities focused on acute care, and the reliance on grant funding without long-term plans for sustainability. Successful programs relied on ED champions to advocate for PrEP and improve staff engagement. Some EDs offered same-day PrEP prescriptions or starter packs, which improved uptake, but most relied on referrals and had low follow-up rates. Patient identification strategies, such as using navigators or risk scores, varied across sites. Education was often led by ancillary staff, as ED providers had limited time and training. Sustainability remained a major challenge, as most programs were dependent on short-term funding. Conclusions To expand PrEP access in EDs, it is essential to address systemic barriers, improve provider training and establish sustainable funding models. Streamlined workflows, dedicated staff, and targeted interventions can help EDs play a more active role in HIV prevention. |
| format | Article |
| id | doaj-art-50bb257aa497460b8ac4ff74fe4004eb |
| institution | OA Journals |
| issn | 2325-9582 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of the International Association of Providers of AIDS Care |
| spelling | doaj-art-50bb257aa497460b8ac4ff74fe4004eb2025-08-20T02:29:05ZengSAGE PublishingJournal of the International Association of Providers of AIDS Care2325-95822025-05-012410.1177/23259582251342842HIV Preexposure Prophylaxis Service Delivery Models for Emergency Departments: A Qualitative StudyEthan Cowan MD, MS0Susie Hoffman DrPH1Laurie J Bauman PhD2Yvette Calderon MD, MS3Tatiana Gonzalez-Argoti BS4Christine T Rael PhD5Jonathan Porter MPH6Joanne E Mantell MS, MSPH, PhD7 , Newark, NJ, USA Department of Epidemiology, , New York, NY, USA , , Bronx, NY, USA , New York, NY, USA , , Bronx, NY, USA , Denver, CO, USA Department of Epidemiology, , New York, NY, USA , Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USABackground Oral preexposure prophylaxis (PrEP) effectively prevents HIV but is underutilized in the United States, particularly among populations with higher incidence of HIV. Emergency departments (EDs), which often care for medically underserved individuals, could play a key role in expanding PrEP access. However, integrating PrEP into ED workflows presents challenges. Methods This qualitative study involved interviews with 22 stakeholders from 15 EDs and 4 sexual health clinics across the United States. Participants included ED leaders, providers, and navigators. The data were analyzed using a PrEP care cascade model, focusing on provider buy-in, patient identification, education, PrEP initiation, and linkage to care. Results Key barriers included limited provider knowledge, ED priorities focused on acute care, and the reliance on grant funding without long-term plans for sustainability. Successful programs relied on ED champions to advocate for PrEP and improve staff engagement. Some EDs offered same-day PrEP prescriptions or starter packs, which improved uptake, but most relied on referrals and had low follow-up rates. Patient identification strategies, such as using navigators or risk scores, varied across sites. Education was often led by ancillary staff, as ED providers had limited time and training. Sustainability remained a major challenge, as most programs were dependent on short-term funding. Conclusions To expand PrEP access in EDs, it is essential to address systemic barriers, improve provider training and establish sustainable funding models. Streamlined workflows, dedicated staff, and targeted interventions can help EDs play a more active role in HIV prevention.https://doi.org/10.1177/23259582251342842 |
| spellingShingle | Ethan Cowan MD, MS Susie Hoffman DrPH Laurie J Bauman PhD Yvette Calderon MD, MS Tatiana Gonzalez-Argoti BS Christine T Rael PhD Jonathan Porter MPH Joanne E Mantell MS, MSPH, PhD HIV Preexposure Prophylaxis Service Delivery Models for Emergency Departments: A Qualitative Study Journal of the International Association of Providers of AIDS Care |
| title | HIV Preexposure Prophylaxis Service Delivery Models for Emergency Departments: A Qualitative Study |
| title_full | HIV Preexposure Prophylaxis Service Delivery Models for Emergency Departments: A Qualitative Study |
| title_fullStr | HIV Preexposure Prophylaxis Service Delivery Models for Emergency Departments: A Qualitative Study |
| title_full_unstemmed | HIV Preexposure Prophylaxis Service Delivery Models for Emergency Departments: A Qualitative Study |
| title_short | HIV Preexposure Prophylaxis Service Delivery Models for Emergency Departments: A Qualitative Study |
| title_sort | hiv preexposure prophylaxis service delivery models for emergency departments a qualitative study |
| url | https://doi.org/10.1177/23259582251342842 |
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