Streamlining Telehealth for Expanded PrEP Utilization through community Partnerships (STEP-UP) - Project Summary/Abstract HIV remains a significant public health challenge in the United States, with new diagnoses concentrated among key populations that continue to experience higher rates relative to the general population. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention tool, but its adoption has been hindered by barriers to healthcare access, resulting in suboptimal utilization rates and limiting its potential to reduce HIV incidence. Telehealth delivery of PrEP (telePrEP) has emerged as a promising strategy for expanding access by overcoming barriers such as transportation, scheduling, and privacy concerns. However, evidence suggests that its reach to individuals at elevated risk for HIV acquisition remains limited, likely due to limitations in technology access, awareness of PrEP, and trust in healthcare systems. To address these challenges, we propose to develop and evaluate STEP-UP (Streamlining Telehealth for Expanded PrEP Utilization through community Partnerships), an innovative model that positions community-based organizations (CBOs) as hubs for PrEP access. STEP-UP builds on the established trust, community expertise, and comprehensive services of CBOs serving individuals at high risk for HIV acquisition, integrating telehealth PrEP delivery into their existing infrastructure through partnership with a local telePrEP program. By enabling CBOs to offer telePrEP navigation within their array of health and social services, STEP-UP creates accessible, comprehensive care centers that address barriers to PrEP access faced by individuals at elevated risk for HIV acquisition. Through a 3-year observational hybrid implementation-effectiveness pilot study, we aim to: (1) identify multi-level determinants of STEP-UP implementation and collaboratively develop protocols through client interviews (n=12) and workflow observations; (2) characterize implementation outcomes including acceptability, cost, and reach to individuals at high risk for HIV acquisition through surveys with STEP-UP participants (n=50), implementation interviews with stakeholders (n=12), and analysis of program data from CBO partner sites; and (3) assess the preliminary effectiveness of STEP-UP in increasing PrEP prescription rates compared to the current direct-to-consumer model through analysis of program data from the telePrEP program. Our proposal brings together a multidisciplinary team of academic researchers, clinicians, community leaders, and public health experts. By rigorously evaluating the STEP-UP model's potential to transform PrEP delivery and advance community health, this project aligns with national public health priorities for HIV prevention. Results from this pilot study will inform future research to adapt, scale, and sustain partner site models as a strategy for improving HIV prevention outcomes. If successful, STEP-UP could serve as a national blueprint for leveraging telehealth to bridge gaps in PrEP access and adoption among individuals at high risk for HIV acquisition.
