Strategies to Support HIV Pre-Exposure Prophylaxis Implementation: A National Programmatic Experience in Sexually Transmitted Infection Clinics.

Background: Pre-exposure prophylaxis (PrEP) is a highly effective human immunodeficiency virus (HIV) prevention method. Expanding access to PrEP is essential to strengthening HIV prevention efforts and supporting national HIV prevention goals. National efforts to improve PrEP services in sexually transmitted infection (STI) specialty clinics were assessed by measuring changes in clinic capacity and patient outcomes and identifying key implementation strategies.

Methods: Quantitative and qualitative data were collected on activities from January 1, 2021, through December 31, 2023, as part of two programs led by the Centers for Disease Control and Prevention. One program supported 26 health department STI clinics in 15 states and the District of Columbia; the other supported the National Network of STD Clinical Prevention Training Centers (NNPTC). Using a mixed-methods evaluation approach, quantitative data included clinic capacity assessments and aggregate visit-level patient outcome measures; qualitative reports were thematically analyzed for PrEP implementation strategies and NNPTC support activities.

Results: Clinics reported increases in PrEP prescriptions and in capacity to provide PrEP services. Five key implementation strategies supporting in-house PrEP provision were identified: navigation services with referral networks, multimedia marketing campaigns, same-day PrEP initiation, long-acting injectable PrEP, and patient-centered education materials. NNPTC supported clinics by offering training, technical assistance, and other resources to address implementation barriers.

Conclusion: STI clinics are a key venue for PrEP delivery. National efforts to expand PrEP services in this setting were supported by tailored implementation strategies and partnership with NNPTC. The findings highlight opportunities to further improve PrEP access and strengthen HIV prevention services nationally.