Introduction: Pre-exposure prophylaxis (PrEP) for HIV—using antiretroviral medication in non-infected individuals to prevent HIV—has immense potential to slow the spread of the virus. However, uptake has been insufficient, and stark racial disparities exist in both HIV acquisition and PrEP usage, making PrEP access a health equity issue. A promising venue to engage high-risk populations in PrEP care is the emergency department (ED); however, existing ED PrEP initiatives have been costly or have had limited success. We hypothesize that two strategies could overcome these barriers: prescribing PrEP during an ED visit and providing patients with an initial supply of PrEP medication in the ED. Here, we describe the results of a qualitative study exploring multidisciplinary emergency clinicians and HIV clinicians’ needs and views about the feasibility of such an initiative.
\nMethods: We conducted 22 semi-structured interviews with multidisciplinary clinicians from an urban, safety-net medical center in the ED and the on-site HIV clinic that provides PrEP services.We performed thematic analysis to summarize challenges and potential solutions described by participants.
\nResults: Participants’ responses fell into three thematic categories: operational challenges; patient-level considerations; and potential impacts. Operational challenges highlighted the difficulty of PrEP initiation in a busy ED and clinician support needs. Patient-level considerations included the complex psychosocial needs of ED patients who could benefit from PrEP. Finally, participants anticipated that an ED-based PrEP initiation program could positively impact both individual patients and public health.
\nConclusion: Interviews with emergency department and HIV clinic staff revealed important considerations and potential solutions for ED-initiated PrEP workflows. Clinicians in both specialties were enthusiastic about such an initiative, which could facilitate its success. This study lays the groundwork for the future design of an efficient and innovative workflow to leverage the ED as an essential entry point into HIV prevention services.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Pre-Exposure Prophylaxis"},{"word":"HIV PrEP"},{"word":"Emergency Department Pre-exposure Prophylaxis"},{"word":"Same-Day PrEP"}],"section":"Endemic Infections","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8t05v6fm","frozenauthors":[{"first_name":"Ezra","middle_name":"","last_name":"Bisom-Rapp","name_suffix":"","institution":"University of California, San Francisco School of Medicine, San Francisco, California","department":""},{"first_name":"Kishan","middle_name":"","last_name":"Patel","name_suffix":"","institution":"University of California San Francisco, Department of Emergency Medicine, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, Department of Emergency Medicine, San Francisco, California","department":""},{"first_name":"Katrin","middle_name":"","last_name":"Jaradeh","name_suffix":"","institution":"University of California, San Francisco School of Medicine, San Francisco, California; University of California San Francisco, Department of Emergency Medicine, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, Department of Emergency Medicine, San Francisco, California","department":""},{"first_name":"Tuna","middle_name":"C.","last_name":"Hayirli","name_suffix":"","institution":"Harvard Medical School, Boston, Massachusetts","department":""},{"first_name":"Christopher","middle_name":"R.","last_name":"Peabody","name_suffix":"","institution":"University of California San Francisco, Department of Emergency Medicine, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, Department of Emergency Medicine, San Francisco, California","department":""}],"date_submitted":"2024-08-13T19:02:12.094000Z","date_accepted":"2024-08-14T20:53:41.275000Z","date_published":"2024-10-22T13:00:00Z","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/33611/galley/28855/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/33611/galley/26415/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/33611/galley/28855/download/"}]}