1. NJ PrEP Initiative Update
New Jersey Department of Health
Division of HIV, STD and TB Services (DHSTS)
Annual Hiv testing site coordinators’ meeting
May 16, 2017
Steven Saunders, MS
Director, HIV Prevention, DHSTS

2. Integrating PrEP Services into NJ’s HIV Prevention Portfolio
PrEP involves taking one pill (Truvada) daily by high risk HIV negative individuals to prevent the acquisition of HIV infection
First and foremost, appropriateness of PrEP is completely dependent upon HIV status. An individual must test negative for HIV prior to initiating PrEP, and free of recent potential exposure
Therefore, PrEP Service Integration occurs at two levels:
At the time HIV testing occurs at a CTS or other testing venue, or by the PrEP Counselor
When PrEP Counselors provide specialized PrEP counseling to those identified by HIV Test Counselors as negative, but at significant risk of HIV infection; self-identified walk in clients may also result from PrEP project marketing efforts

3. Integrating PrEP Services into NJ’s HIV Prevention Portfolio
Training
DIS
CBOs No
PrEP
HRN
PrEP
Counselor
PrEP
PrEP
Prescriber
Clients Who May Choose PrEP
HIV
TEST
HRN
HIV+
HIV
Care Navigator
Partners
Tested
HIV+
Description of the workflow:
Anyone accessing an HIV test site is screened for PrEP eligibility. These testing sites probably look very similar to the entities in your communities. Individuals that test positive for HIV are referred to HIV care, and partner testing is encouraged.
For clients that test HIV negative but deemed to be high risk for acquiring HIV, they are referred to the PrEP counselor. If clients are ready to initiate PrEP, they are referred to a PrEP prescribing clinician.
Clients who do no wish to take PrEP are encouraged to continue return for subsequent HIV testing, as well as other services.
CTS
STD/PP Clinics
HIV
Clinics
DIS = Disease Intervention Specialists (DHSTS Partner Services staff)
CBOs = Community-based organizations
CTS = Counseling and testing sites, non-targeted
HRN = High-risk negatives
STD/PP = Sexually transmitted disease/Planned parenthood

4. The New Jersey HIV PrEP Counselor Initiative
By early 2016, eight geographically dispersed HIV PrEP Demonstration Projects were established. Following two RFAs in 2016, an additional nine new PrEP Counselor projects were added in July, 2016 and seven more in January, 2017.
As a result, there are now 24 funded PrEP Counselors located across the state, nine of which are co-located at HIV prevention projects that serve gay and bisexual men, 11 in HIV clinics, one in an Adolescent/Young Adult Medical Clinic, one in an STD clinic and two in planned parenthoods that are women-focused PrEP projects.

5. PrEP Counselor Sites Asbury Park - VNA
Atlantic City – Atlanticare Medical Center and South Jersey AIDS Alliance
Camden - AHEC and Cooper Health Systems
Cumberland County - Complete Care Health Network (Millville, Vineland and Bridgeton)
Elizabeth – Trinitas Regional Medical Center
Hackensack - Buddies of NJ
Jersey City - Hudson Pride and Jersey City Medical Center
Morristown – Morristown Medical Center
Neptune- Jersey Shore Medical Center
Newark- Newark Beth Israel Medical Center, St Michaels Medical Center, Rutgers University Hospital IDP and DAYAM, North Jersey AIDS Alliance
Perth Amboy – PP of Northern, Central and Southern NJ
Paterson- Hyacinth AIDS Foundation, PP of Metropolitan NJ, Paterson Health Department STD Clinic
Plainfield - Hyacinth AIDS Foundation
Trenton - Henry J. Austin Health Center and Hyacinth AIDS Foundation

6. PrEP Counselors....
Provide PrEP education and general HIV risk reduction counseling
Conduct in-depth HIV risk assessment to determine benefit of a PrEP referral
Assess client readiness for PrEP regimen and medical follow-up
Provide initial rapid HIV testing to screen out HIV+ (referred to Navigator)
Assess client insurance status and complete insurance pre-authorization paperwork
Refer client to medical professional to prescribe PrEP and do initial medical exam
Provide additional supportive referrals
Assist clients with adherence plans and monitor adherence between visits
Develop local social media and social marketing campaigns to create awareness of PrEP and the PrEP Counselor services at each of their programs

7. PrEP Counselor Data Jan-Dec, 2016
WHO WERE THE PrEP CLIENTS IN 2016?
563 new clients seen by 17 PrEP Counselors
80% male, 19% female and 1% Transgender
46% Black, 45% White, 1% API, 8% other or not reported
29% Latino
30% years old, 33% years old
72% Gay/Bi/Other MSM, 17% Women, 8% Discordants, 1% TG, 1% IDU, 1% Other

8. PrEP Counselor Data Jan-Dec, 2016
WHAT WERE THE OUTCOMES FOR THESE CLIENTS?
545 (97%) referred to medical practitioner for PrEP prescription & initial exam
31 (6%) “failed” the risk assessment but wanted PrEP anyway and were referred – why is this important? client-centered, not provider-centered
145 (27%) required two or more PrEP Counselor visits before linking to PrEP
– why is this important? PrEP Case Management vs. PrEP Counseling
477 (87%) kept or had a pending first appt with prescriber; 13% failed to keep their appt
239 (44%) kept a second 90-day medical appt for refill (data loss for clients on own)
273 (50%) on PrEP for six months; 41 (8%) for a year (incl. clients prior to 1/1/16)
47 (9%) deactivated; 1 seroconversion in a non-adherent client

9. Counselors provided 1,663 sessions in addition to initial PrEP Counseling sessions by topic:

10. Program Activities for 2017
Continue to provide PrEP Counselor Training
Integrate PrEP into HIV Test Counselor Training
Continue to hold quarterly PrEP Counselor Meetings
Develop a list of PrEP Prescribers in New Jersey
Implement new web-based client-level data collection system to replace current aggregate data collection methods
All existing HIV Test Counselors to complete the on-line PrEP training module from Rutgers.

11. on-line PrEP training module from Rutgers link for registration: http://hiv.rutgers.edu/training/

12. New Jersey HIV PrEP Counselor Initiative
THANK YOU
&
QUESTIONS