Initiatives

PrEP for Women Initiative

 

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D.C. PrEP for Women Initiative

The D.C. PrEP for Women initiative is a public-private partnership between the Washington AIDS Partnership and the D.C. Department of Health’s HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA). It aims to increase knowledge and use of Pre-Exposure Prophylaxis (PrEP) among women of color in Washington, D.C. PrEP allows individuals at high risk for HIV infection to take HIV medication regularly to lower their chances of getting infected.  With generous support from the MAC AIDS Fund, the D.C. PrEP for Women initiative is one of the first city-wide programs in the country to focus specifically on PrEP for women of color.

Goals for the initiative include:

  1. Leverage HIV and women’s health providers to adopt and offer PrEP as an effective strategy to reduce HIV infection;
  2. Educate women at high risk for HIV to normalize and increase interest in PrEP;
  3. Change and expand the conversation about PrEP and women from “protecting her from him” to “taking care of yourself;” and
  4. Increase the knowledge and number of health providers prescribing PrEP for women.

Why PrEP for Women?

At least 1.9% of Washington, D.C. residents (12,964) are living with HIV, surpassing the WHO’s 1% threshold for a generalized epidemic [1] The lifetime risk for HIV diagnosis, the likelihood a person will be diagnosed with HIV during their lifetime, is 1 in 13 for D.C., the highest in the U.S.[2] Furthermore, Black women with heterosexual contact as mode of transmission represent the second largest group (15%) of persons newly diagnosed with HIV in the District.[3]

PrEP has tremendous potential to reduce the infection risk among women in D.C. When taken consistently, PrEP has been shown to reduce the risk of HIV infection among individuals at high risk by up to 92%.[4] However, there is a significant PrEP awareness gap among women of color. In a recent focus group conducted for HAHSTA, the participants’ initial reaction was anger that there had not been prior communication to them about PrEP. Women who took part in a six-city focus group study had the same reaction, with almost none of the participants having heard of PrEP before.[5] In another set of focus groups conducted by the Women’s Interagency Health Study, HIV-negative D.C. women expressed enthusiasm about PrEP, and wanted to use and recommend it to others.[6]  Locally and nationally, focus group participants were highly interested in PrEP as a woman-controlled prevention strategy, as long as barriers such as cost, efficacy knowledge, distrust of the medical system, and stigma (including unwillingness to discuss PrEP with provider) were addressed.[7]

Grantmaking

In January 2017, the Washington AIDS Partnership funded three innovative PrEP for Women projects: Children’s Research Institute, Mary’s Center for Maternal and Child Care, and Planned Parenthood of Metropolitan Washington. These organizations were funded to integrate PrEP into existing clinical services and to educate patients and health provider staff about PrEP as an option to reduce HIV risk. Additionally, Children’s Research Institute will support PrEP capacity building by training outside health care providers who serve adolescents at high risk for HIV. In June 2017, WAP awarded funding to Family and Medical Counseling Service to host small group presentations focused on PrEP with D.C. women at high risk for HIV.

The Washington AIDS Partnership chose its grantmaking focus to address two key components of PrEP uptake: decreasing the PrEP awareness gap among women, and increasing the PrEP capacity and expertise of health care organizations who serve women.

 Children’s Research Institute

Children’s Research Institute (CRI) is the academic arm of the Children’s National Health System (CNHS), an internationally recognized provider of pediatric services in the Greater Washington region. CRI operates a successful pediatric emergency department (ED) HIV point-of-care testing and STI screening program at United Medical Center (UMC), located in Ward 8. PrEP for Women funding supports the integration of PrEP into the UMC ED HIV/STI screening program.

To date, CRI has integrated PrEP into the screening program, educated 21 ED health providers and 16 ED staff on how to discuss PrEP with patients and their guardians, and developed youth- and female-friendly PrEP educational materials. Program staff have educated 221 patients about PrEP through various stages of the STI/HIV screening process. They have also begun mapping primary care providers (PCPs) of young women with a positive STI test in the past year.

Mary’s Center for Maternal and Child Care

Mary’s Center for Maternal and Child Care is a federally qualified health center providing medical, education, and social services for patients at three sites across Washington, D.C. and Maryland. Part of Mary’s Center’s mission is to embrace culturally diverse communities to provide them with the highest quality of care, regardless of ability to pay. PrEP for Women funding supports the integration of PrEP into Mary’s Center’s existing services.

To date, Mary’s Center has created a comprehensive staff training program, educating 61 clinical and 124 non-clinical staff across several locations. Through their innovative “Two Steps to PrEP” model, patients are seen by a provider to assess PrEP eligibility and then referred to the sexual health nurse for more detailed education on PrEP and care coordination. They have educated 286 individuals about PrEP through HIV/STI screening and individual counseling with the sexual health nurse, and initiated 47 patients on PrEP. They have also developed PrEP marketing materials and conducted outreach events to educate participants about PrEP, including learning circles on the campus of Howard University.

Planned Parenthood of Metropolitan Washington

Planned Parenthood of Metropolitan Washington (PPMW) provides quality affordable health care and education for women, men, and teens in the Greater Washington region. PrEP for Women funding is helping PPMW expand its reproductive health and educational services to include PrEP. Integrating PrEP into a family planning setting is a promising strategy as women’s health providers already have extensive experience with and regular access to their female patients.

To date, PPMW has established an internal training plan and provided comprehensive training to 53 clinical and 9 non-clinical staff. They have initiated PrEP services at all three D.C.-area health centers. PPMW providers have begun incorporating brief PrEP education and counseling into encounters with high-risk patients.

PPMW has also integrated PrEP into community education curriculum and educated 250 individuals through small group education sessions. They have also tabled at 15 community events and provided PrEP information to 2,240 individuals. They have created PPMW-branded PrEP marketing materials, including palm cards and patient guides as well as a PrEP webpage, which can be found here.

Family & Medical Counseling Service, Inc.

Family and Medical Counseling Service, Inc. (FMCS) is a community-based, federally qualified health center that addresses the needs of the African American community east of the river, with culturally sensitive, compassionate, and high quality health care. FMCS has been funded to host community conversations focused on PrEP with District of Columbia women at high risk for HIV, including small group presentations and a town hall meeting. To date, they have hosted over 21 small group presentations, reaching 299 women. These sessions have taken place throughout the city, with a focus on facilities that serve women at high risk for HIV, including treatment facilities, agencies that work with returning citizens, and organizations that provide supportive services for women and preventive case management.

Through the Washington AIDS Partnership’s PrEP for Women grantees and the initiative’s staff, a total of 264 clinical and 149 non-clinical staff have received PrEP training, and 4,563 individuals at risk for HIV have been educated about PrEP. As part of the initiative’s partnership with HAHSTA, a social marketing campaign focused on raising PrEP awareness among African American women was also launched. The key campaign theme “Dominate Your Sex Life,” encourages and empowers women to ask their provider about PrEP. The campaign includes a website; a television commercial; social media presence; print, online, radio and television paid advertising; and events and outreach. These efforts have reached hundreds of thousands of women in the D.C. area.

For more information on PrEP, please visit www.prepforher.com.

 

[1] DC Annual Epidemiology & Surveillance Report: 9. Released 2017.
[2] Centers for Disease Control and Prevention 2016 Lifetime HIV Risk Diagnosis Factsheet. http://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html. February 2016.
[3] DC Annual Epidemiology & Surveillance Report: 9. Released 2017.
[4] Centers for Disease Control and Prevention Pre-Exposure Prophylaxis (PrEP). http://www.cdc.gov/hiv/risk/prep/ July 2016.
[5] Knowledge, Attitudes, and Likelihood of PrEP Use. Auerbach et al. AIDS Patient Care STDS. 2015 Feb;29(2):102-10.
[6] Women want Pre-Exposure Prophylaxis but are Advised Against it by Their HIV-positive Counterparts. Goparaju et al. J AIDS Clin Res. 2015; 6:521.
[7] Knowledge, Attitudes, and Likelihood of PrEP Use. Auerbach et al. AIDS Patient Care STDS. 2015 Feb;29(2):102-10.