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PrEP Provider Toolkit

Uplifting BIPOC for PrEP Uptake

What Providers Can Do To Improve PrEP Utilization Among BIPOC People?

  1. Prior to meeting your patient:
    • Check your bias and personal story: what baggage do you bring to the table?
    • Look at their chart to get a sense of who they are
    • Beware of microaggressions
      1. Don’t speak in generalities
      2. Don’t assume race/ethnicity
      3. Don’t assume gender/sexual identity
      4. Don’t assume pop culture references
      5. Condescension while being questioned
  1. What to bring to the patient interaction?
    • Any member of the care team (e.g., PrEP Navigator, Case Manager) can learn about the familial context and/or patient’s culture and share what they learn with the provider and/or providers can build rapport by expressing an interest in learning about these aspects of the patient's life as they get to know each other
    • Questions around culture
    • Familial Context
      1. Learn about the familial responsibilities of the patient
      2. Learn about the patient’s biological/chosen support system
      3. Ask about personal & familial experience with health insurance
      4. Ensure prescriptions are affordable within the patient’s budget
      5. Discuss ease of getting to your clinic
      6. Discuss ease of physically accessing referral care and/or pharmacies
    • Words Matter
      1. Providers can utilize a mutually agreed-upon opening script within the clinic about how to frame these questions. An example could be: "I'm interested in learning about how we can support you now or in the future" or "it's important to me to know if there are any issues that are coming up even if I can't help right away"
      2. It is not “dumbing-down” to speak to patients in a culturally-responsive manner
      3. If you do not speak their vernacular, learn
      4. If you misspeak & offend, apologize
      5. Watch for “Why” questions: instead of asking “Why do you want to take PrEP?” or “why don’t you use condoms,” you can ask “Tell me about what makes you want to take PrEP” or “Tell me about how you make decisions about condoms”
      6. Do not ask: “Do you understand?”
      7. Ask: “Please tell me what you think I said. It is important that we are on the same page.”
    • Support Resilience
      1. It is important to “reframe the misconception to see [Black LGBTQ people] as “at risk” and instead see them as “at promise” for a future of good health and well-being anchored in their own resilience and supported by our abilities as staff, providers, and institutions to provide services to contribute to their resilience.”
        1. Consider exploring strengths and coping strategies by asking: What do you love about yourself? What has helped you to keep going even when times are hard? How can I best help you as you start PrEP?
    • Care to Treatment
      1. Take time to address fears about a particular drug, pharmaceutical company, or the healthcare industrial complex. Take care not to argue a point, but rather to hear their perspective/concerns, then ask for permission to share additional information or your experience as a clinician, if appropriate.
      2. Storytelling of other patients’ experiences with medication is key for trust
      3. Share personal experience when appropriate, this is critical when recommending preventative care
      4. Be transparent if you or your clinic have been involved with any clinical trials or are receiving funding from pharmaceutical companies
  1. Create a safe & welcoming clinic
    • Staff Diversity
      1. Actively engage clinic leadership to champion Diversity, Equity, Inclusion and Anti-Racism efforts.
      2. Hire and retain staff that reflect the patient population, especially clinicians
      3. Encourage clinic leadership (including Human Resources) to adopt workplace policies, procedures, and compensation rates that foster retention of a culturally concordant workforce.
      4. Speak with staff and conduct quarterly trainings on cultural responsiveness.
    • Have inclusive imagery and signs visible.
    • Have BIPOC-centric brochures & magazines in waiting areas
    • Post a Diversity & Inclusion statement in a conspicuous location
  1. Bringing them back to care
    • Before the patient leaves the visit:
      1. Confirm the best form of future contact
      2. If you have a portal, make sure that it is on their mobile phone
      3. Ask them to send you a Test Message
      4. Introduce them to the person(s) who may follow-up
    • Patients, clients, customers may come once, but maybe not again
    • Look at your client-level data and see if your BIPOC clients are coming back for their appointments
    • It’s probably not them … It may just be you (and/or your staff)
      1. Conduct an anonymous survey of patients
      2. Be committed to receiving feedback and change
      3. Reiterate that you are committed to their success
      4. Ask for a verbal report card before the patient leaves

Address Social Determinants of Health whenever possible. One of the findings in a PrEP navigation study highlights the benefit of offering clinical and non-clinical PrEP services to clients in one place which facilitates clients’ access to PrEP services. A co-located approach can ameliorate barriers such as time constraints, PrEP cost and lack of insurance, and low/limited income. This is particularly important when there is a low PrEP uptake among racial and gender minorities who are disproportionately affected by HIV.

  • Hire a PrEP Navigator or train community health workers in PrEP Navigation
  • Partner with eligibility workers to optimize insurance coverage
  • Support with transportation benefits
  • Connect to food and housing resources
  • Connect to benefits/social services providers
  • Follow up on any issues related to medication or care related costs or delays

Make PrEP easier to talk about:

  • Talk about PrEP with everyone.
  • Mention PrEP with every HIV test order/result universally.
  • Make PrEP easier for patients to get:
    • Stock generic PrEP and use it as first line agent (cost-effective).
    • Offer tele-prep follow-up as an option.
    • Do not withhold next prescriptions due to missed appointment (as long as the HIV test is complete and negative).

Offer options:

  • Consider offering a 1-month follow-up if the patient is ambivalent or unsure about adherence (before extending to every 3 month visits).
  • Honor choice: Continue to offer all tools in the HIV prevention toolkit even if it’s not the provider’s preference.
  • If patient is not ready for sexual history discussion on first visit, that’s ok. Revisit this discussion at next appointment or when rapport is built.
  1. Greater than AIDS PrEP campaign “Powered by PrEP”: POC centered messaging including testimonials in English and Spanish
  2. REACH LA’s WAP campaign
  3. Black AIDS Institute: black cis women
  4. Cardea: HIV Care for Native patients
  5. Labeling transwomen as MSM
  6. MSM of color - Leo Moore presentation
  7. People of trans experience - evidence of lack of interaction with gender-affirming hormones
  1. Reproductive health - evidence of safety in conceiving, pregnancy & lactation. (HIVE toolkit)
  2. Seicus PrEP Education for Youth-Serving Primary Care Providers Toolkit
  3. Lack of diversity in healthcare Infographic
  4. National LGBT Health Education Center: “Understanding and Addressing the Social Determinants of Health for Black LGBTQ People”
  5. Same-day Oral PrEP quick guide: https://www.ebgtz.org/resource/same-day-prep/