856. Barriers to PrEP Implementation among Patient-Facing Staff in Three Urban Clinics

Abstract

Abstract Background PrEP implementation has lagged in the US. The role of multidisciplinary staff in PrEP rollout has been neglected. We sought to identify barriers to PrEP implementation among 3 urban federally qualified health centers (FQHCs) in Connecticut that provide HIV and PrEP services in order to inform development of staff training. Methods A link to an anonymous survey was emailed to patient-facing staff members or posted at the end of staff trainings October 2020-April 2021. The survey requested demographics, duration of employment, and using 4 and 5 point Likert scales, ascertained knowledge and beliefs toward PrEP based on established scales, and perceived individual and systemic barriers to PrEP uptake. Results Among 101 respondents, 40% were 36-54yo, 22% were male, 68% were non-prescribing clinicians, and median duration of employment was 6 years (IQR 2-14). Among 32 (31%) prescribers (physicians, PAs, APRNs), 97% felt comfortable discussing sexual risk with patients, though 15% were not familiar with PrEP efficacy and safety data, 28% responded that PrEP use would encourage risky behaviors, 34% were concerned about side effects, 53% responded that educational and behavioral interventions should be attempted prior to prescribing PrEP, and 59% identified lack of provider training as a barrier. Among 69 (68%) non-prescribers, barriers to PrEP uptake included: patients don’t ask for PrEP (43%), lack of insurance (47%), lack of clinic guidelines/protocol (42%), and staff time for counseling (31%). Conclusion Prescribers and non-prescribers identified distinct individual and systemic barriers to PrEP uptake at FQHCs. Among prescribers, uncertainty regarding indications for and safety of PrEP exist, which will be addressed with targeted training. Non-prescribers identified the need for patient outreach, financial assistance, and counseling as the top priorities. The input of clinic multidisciplinary team members is essential to addressing barriers to PrEP implementation. Disclosures Sheela Shenoi, MD, MPH, Merck (Other Financial or Material Support, SS’s spouse worked for Merck pharmaceuticals 1997-2007 and retains company stock in his retirement account. There is no conflict of interest, but it is included in the interest of full disclosure.)