In the state of Utah, incidences of HIV infection had been increasing since 2011, but has stabilized since then. In 2016, young men who have sex with men (MSM) age 25-44 had the highest rate of new infection. 63% of males with newly diagnosed HIV reported MSM as their only risk factor, and 12% reported MSM along with injection drug use. Estimates in the US are that 15% (1 in 7 adults) age ≥18 are unaware of their HIV diagnosis. Among youth (age15-24) approximately 60% (3 in 5 youth) are unaware of their diagnosis.
In 2012, the FDA approved tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for use as HIV pre-exposure prophylaxis (PrEP). TDF/FTC is the only FDA-approved medication for PrEP. Daily PrEP has demonstrated lowering the risk of HIV acquisition more than 90% in multiple clinical trials and recently received an “A” level recommendation from the United States Preventive Service Task Force. Currently, outpatient PrEP services allow high-risk individuals the ability to decrease their risk for HIV acquisition and offer frequent HIV and sexually transmitted infection (STI) testing, treatment, and education. Despite the clear preventive benefits of PrEP, uptake among populations at highest risk of HIV acquisition has been limited by lack of health insurance and access to care.
Since the 1980s, infectious disease physicians in Utah and at University of Utah have treated approximately 90% of HIV cases in Utah. Concerned for both the increased incidence of HIV and lack of access to care, providers in Clinic 1A at the University of Utah HIV outpatient clinic partnered with leadership in the university school of medicine, the Utah Department of Health, university college of nursing, and the Utah AIDS Foundation to create a new HIV prevention clinic known as the PrEP Community Clinic.
After many meetings between providers, nursing administration, laboratory, pharmacy, and case management/social work in the University of Utah Health System, a free HIV prevention clinic came together in early 2018. Seed funding was provided by the university internal medicine department and funding to cover lab testing from the university clinical laboratory, ARUP. Case Management and pharmacy collaborated to secure vouchers from the manufacturer to provide free PrEP medication and a university health community clinic had provided free clinic space to use. Clinic doors opened at the beginning of March 2018, with a full schedule and staffed with volunteer providers, medical and nursing students, and social workers, each with a specific best practice work flow assigned.
The PrEP Community Clinic actively enrolls new patients, in particular those without health insurance, and is the single largest provider of HIV preventive services in Utah. A formal partnership with the state health department involving funding of the clinic for the next five years has been negotiated. With the success of the free PrEP clinic, plans now are to open another free PrEP clinic at the main university hospital opening January 2019. Other plans are to seek funding for a mobile clinic to provide free PrEP in targeted areas of the community.