By Terrance Afer-Anderson
Norfolk Health District
The Norfolk Department of Public Health will be establishing a HIV Pre-exposure Prophylaxis (PrEP) clinic and collaborating with local health and community based organizations to tackle the region’s HIV epidemic.
PrEP – a pill taken once a day, every day at the same time – is the latest prevention tool in the HIV prevention toolkit.
“For the first time, we have an additional weapon that we can offer to provide protection against HIV infection,” said Dr. Demetria Lindsay, director of the Norfolk Health District. “Daily PrEP and proper condom use can reduce the risk by more than 90 percent.”
The health department will be participating in two new programs – Bridges 757 and Project PrIDE – aimed at cutting the number of new HIV infections in the Hampton Roads area, the region of the state with the highest number of HIV infections. Both program are funded by the Centers for Disease Control through the Virginia Department of Health and cover the entire Hampton Roads area.
“Our goal is to ensure that people are aware of PrEP and that anyone at risk has the opportunity to receive preventive treatment,” she said. – “While safe and effective, this is not a miracle cure-all and education and adherence to recommended preventive practices, such as condom use, are very important to further reduce the risk of HIV and other Sexually Transmitted Infections, STIs.”
PrEP is appropriate for “HIV negative people who are either men who have sex with men, transgender individuals, heterosexuals, or people with a current or past history of IV drug use, that meet the following criteria: has either an HIV positive partner, multiple partners, a partner who has multiple partners, a partner whose HIV status is unknown, people who have had sex, especially anal sex, without a condom with people who use IV drugs or bisexual men.
“A major challenge,” she said, “is getting the word out. Cost should not be a barrier for receiving PrEP that it is covered by most insurance programs and medication assistance programs are also available to help those who do not have insurance.”
Norfolk Health District Business Manager H. Paul Brumund added, “Encouraged by our capacity to implement a biomedical HIV prevention strategy, in partnership with local medical and community-based organizations, we began preparations for PrEP this summer.”
The program was developed in three stages: 1) Assessment of our capacity to deploy it 2) Identification of essential community resources for prevention, care, behavioral health, social services 3) Expansion of current clinical and disease intervention strategies.
“A new clinical practice,” he said, “has been established to improve access for the target populations, increase number of clients served, reduce clinic visit time, and incorporate PrEP into existing STI clinic services.”
Brumund added, “An additional challenge of planning PrEP was defining the unknown, specifically, how many people would access services, how increased patient volume would impact clinic flow, and how to structure collaboration with community partners already providing similar services. Project PRIDE and Bridges and VDH helped us to put all the pieces of the program together,” he said.
“This includes a senior nurse, who will coordinate PrEP with other STI services, and two disease intervention specialists, tasked with assisting patients with medication compliance, gaining access to social services, and expanding patient volume.” Brumund also noted that a Health Educator will be hired, “to enhance collaboration with community partners and that PrEP program staff will engage in community outreach, such as education and counseling, and some clinical services.
“Norfolk PrEP participants,” Brumund said, “will be assessed for their HIV risk and their willingness to adhere to the medication plan and required laboratory tests. The next step is free HIV and STI screenings, followed by a latter visit, for PrEP medication and additional consultation.”
Public Health Nurse Practitioner Monkia Brown will be working on the front lines of the Norfolk PrEP programs. She said, “My clinical experience, providing both STI and family planning education and care, allows me to build trusting relationships with people from all walks of life in the target community.” She added, “Having received PrEP training from Johns Hopkins University, I not only acquired skills essential in managing a busy PrEP clinic, but will also be assisting the Norfolk Health District in aligning itself with community partners.
“I believe our greatest challenges will be creating public awareness of the new PrEP clinic and establishing stronger relationships with the LGBT community,” she said. “This could be achieved by partnering with prominent LGBT community organizations and clubs, alerting them to the urgent need to stem the tide of local HIV infection.”
Brown noted, “The greatest need for the target population is EDUCATION,” adding, “The greatest issue is the lifestyle choices made. When the LGBT community is effectively educated on safe sexual health practices, I feel the PrEP clinic will be tremendously successful.”
Lindsay’s expectations are for a very successful program, but she noted, “We will continue to tract the rates of HIV in our community, with the ultimate goal of seeing a reduction in the number of people contracting and living with the effects of this disease on their health and quality of life.”
For more information on Norfolk PrEP, please contact Nancy Cisco, RN, Nurse Consultant, at (757) 683-2737 or Nancy.Cisco@vdh.virginia.gov