1. Eliminating Barriers to Increase Uptake of PrEP in a Community- Based Clinic in San Francisco Presenting Author: Pierre-Cédric Crouch, PhD, ANP-BC, ACRN, Director of Nursing Magnet @Strut-San Francisco AIDS Foundation Authors: S. Gibson, K. Freeborn, J. Hecht, J. Gagliano, T. Patriarca, J. Auerbach, R. Grant, W. Lyon, C. Hall FRAE0104

2. Conflict of Interest Disclosure San Francisco AIDS Foundation receives funding from Gilead Sciences, Inc. SAN FRANCISCO AIDS FOUNDATION2

3. SAN FRANCISCO AIDS FOUNDATION3 1 2 3 4 Background PrEP Health Program Description Demographics and Outcomes Lessons Learned

4. SFDPH HIV Testing Priorities Services for Gay, Bi, Trans*, or Queer Men Magnet –Sexual Health Services Stonewall –Mental Health and Substance Use Services Community Engagement Programs SAN FRANCISCO AIDS FOUNDATION4 Background: Strut

5. SFDPH HIV Testing Priorities SAN FRANCISCO AIDS FOUNDATION5 Background: Identified Barriers Provider willingness Ease of access Cost of medication Sustainable Nurse-led delivery Same day PrEP initiation Full benefits navigation Non-research based funding

6. Sexual Health Program PrEP Health Program ❖ Launched November 2014 ❖ PrEP Initiation and Follow Up ❖ Referral to Primary Care for non- PrEP related care SAN FRANCISCO AIDS FOUNDATION6 Sexual Health Services ❖ HIV testing: Rapid antibody and HIV pooled RNA ❖ Testing and Treatment of: ❖ Gonorrhea/Chlamydia ❖ Syphilis ❖ Vaccinations ❖ Influenza ❖ Hepatitis A/B ❖ Pertussis, Tetanus, Diphtheria ❖ Meningococcal

7. SAN FRANCISCO AIDS FOUNDATION7 Nurse Practitioners Point of care: HIV Ab, Metabolic panel, Hep C Ab, HCG Labs: HIV RNA, Syphilis VDRL, Hep B Ag, Gonorrhea & Chlamydia NAAT Medical evaluation Motivation for Initiating PrEP Sexual Health Plan: Condoms & Seroadaptive behaviors Adherence plan Stigma PrEP counseling & education Navigators to handle insurance and Advancing Access (Gilead) Covered California Enrollment Center Notarize documents Benefits navigation 3 day phone call 30-day follow-up, then every 3-months Managed by Registered Nurses, HIV Test Counselors, Nurse Practitioners Follow-up PrEP Health Program

8. Number screened = 1252  95.5% enrolled Gender Identity  Cis gender men 1249, 99.7%  Trans* men 3, 0.002% Age in years  Mean 35.4, SD 32.4  Range 18 – 72 years Sexual partners in last year  Mean 17.4, SD 36.1  Median 10 SAN FRANCISCO AIDS FOUNDATION8 Overview: Who is Showing Up Indication for initiating PrEP:  Condomless Sex (92.7%)  Monogamous HIV+ partner (3.8%)  Low-risk (3.6%)  Consistent condom use

9. SAN FRANCISCO AIDS FOUNDATION9 Overview: Ethnicity/Race 1.http://www.census.gov/quickfacts/table/PST045215/0667000 2.https://www.sfdph.org/dph/files/reports/RptsHIVAIDS/HIV-SemiAnnualReport122015.pdf

10. SAN FRANCISCO AIDS FOUNDATION10 High Retention Rates Client considered lost 1 month after missed visit. Overall 71% retention. Includes: transfer of care, discontinuation, and physical move. Nb: Cross-sectional data by visit

11. SAN FRANCISCO AIDS FOUNDATION11 Strong Adherence Rates Nb: Cross-sectional data by visit

12. SAN FRANCISCO AIDS FOUNDATION12 Incidence of STI Nb: Cross-sectional data by visit

13. SAN FRANCISCO AIDS FOUNDATION13 Behavior Change 92.7% reported condomless sex at initiation Nb: Cross-sectional data by visit

14. SAN FRANCISCO AIDS FOUNDATION14 HIV Infections No HIV infections in the PrEP Health Program There were 82 HIV infections in the clinic since the program launched

15. PrEP Delivery –Community Based Organizations –Must actively reach those at risk –Nurse-led PrEP is: –Easy –Safe –Effective –Needed SAN FRANCISCO AIDS FOUNDATION15 Pierre-Cédric Crouch, left, discussing with Jesse Eller the clinic's PrEP program. Credit: Max Whittaker for The New York Times Lessons Learned

16. The city’s success is not only shrinking the epidemic. It is changing the psychology of gay sex here in unexpected ways. The fear of death — so long a part of being gay in America — appears to be receding. “PrEP has really changed the game,” Paul said. “It’s really nice to still be around now and see a younger generation go through what we did. I grew up in the ’70s with no fear. The guys in the ’90s were full of fear. Now guys are growing up with no fear at all.” - Donald G. McNeil Jr., New York Times, (October 5, 2015) SAN FRANCISCO AIDS FOUNDATION16 Lessons Learned

17. Special Thank You To: Magnet staff & 100+ volunteers The 1252 men who have enrolled in our PrEP Health Program! SAN FRANCISCO AIDS FOUNDATION17 Protocols available here http://tinyurl.com/magnetprep Thank You to Our Team and Community! Questions? Pierre-Cédric Crouch pcrouch@sfaf.org 415.581.1606

18. SAN FRANCISCO AIDS FOUNDATION18 sfaf.org 1035 Market Street, Suite 400 | San Francisco, CA 94103