title: Successful Implementation of HIV Preexposure Prophylaxis: Lessons Learned From Three Clinical Settings.
abstract: The past 3 years have marked a transition from research establishing the safety and efficacy of HIV preexposure prophylaxis (PrEP) to questions about how to optimize its implementation. Until recently, PrEP was primarily offered as part of randomized controlled trials or open-label studies. These studies highlighted the key components of PrEP delivery, including regular testing for HIV and other sexually transmitted infections (STIs), adherence and risk-reduction support, and monitoring for renal toxicity. PrEP is now increasingly provided in routine clinical settings. This review summarizes models for PrEP implementation from screening through initiation and follow-up, focusing on the strengths and weaknesses of three delivery systems: a health maintenance organization, an STI clinic, and a primary care practice. These early implementation experiences demonstrate that PrEP can be successfully delivered across a variety of settings and highlight strategies to streamline PrEP delivery in clinical practice.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 2nd Floor, Oakland, CA, 94612, USA.
authors.forename: Julia L
authors.initials: JL
authors.lastname: Marcus
authors.affiliation: Kaiser Permanente Northern California, San Francisco Medical Center, 2238 Geary Boulevard, San Francisco, CA, 94115, USA.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Volk
authors.affiliation: One Medical Group, 201 Spear St. Suite 230, San Francisco, CA, 94105, USA.
authors.forename: Jess
authors.initials: J
authors.lastname: Pinder
authors.affiliation: San Francisco Department of Public Health, University of California, 356 7th Street, San Francisco, CA, 94103, USA.
authors.forename: Albert Y
authors.initials: AY
authors.lastname: Liu
authors.affiliation: San Francisco Department of Public Health, University of California, 356 7th Street, San Francisco, CA, 94103, USA.
authors.forename: Oliver
authors.initials: O
authors.lastname: Bacon
authors.affiliation: Kaiser Permanente Northern California, San Francisco Medical Center, 2238 Geary Boulevard, San Francisco, CA, 94115, USA.
authors.forename: C Bradley
authors.initials: CB
authors.lastname: Hare
authors.affiliation: San Francisco Department of Public Health, University of California, 356 7th Street, San Francisco, CA, 94103, USA. stephanie.cohen@sfdph.org.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Cohen
mesh_terms: D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care; D000068679:Emtricitabine / Q000627:therapeutic use*; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control*; D006279:Health Maintenance Organizations; D006801:Humans; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D011320:Primary Health Care; D040242:Risk Reduction Behavior; D000068698:Tenofovir / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D000068698:Tenofovir; D000068679:Emtricitabine
keywords: Delivery of health care; Human immunodeficiency virus (HIV); Implementation; PrEP delivery; PrEP implementation; Preexposure prophylaxis (PrEP); Review; Science of prevention; Sexually transmitted infections