Table 3.

Resource-Related Barriers and Facilitators to PrEP Implementation, by Step of PrEP Care.

Resource	Exemplar Quote
Step 1: Assessing HIV Risk
Formal, standardized HIV risk assessment tool	“So on their risk assessment they usually have to fill out – how many partners they’ve had, if they’ve had any STDs in the past six months, what types of sex that they’re having, are they currently having sex with someone who’s HIV positive? – so that risk assessment normally is a good guide on letting me know if they will be a good candidate for PrEP from the jump before I even start discussing anything with them.” (Clinic 15, Model 3)
Available staff to conduct HIV risk assessment prior to appointment	“The nurses do the assessment. We don’t have any sheets that we pass out before they get there. So during the intake is when all [HIV risk] is assessed and put into the computer and then the nurses talk to them. And then when I go in the room after reviewing the chart, I look at the answers, and then I go in and reinforce or teach or educate depending on what’s going on.” (Clinic 9, Model 2)
Incorporation of HIV risk assessment in electronic medical records	“We have electronic medical records, so if they could… get to the point where they did [HIV risk assessment] actually in an electronic history, then it could just populate it in the chart.” (Clinic 4, Model 1)
Step 2: PrEP Education
Patient educational materials	“We have some really good tools in terms of patient education sheets on PrEP that we can provide to patients that go over what the potential risks are, what the side effects are, what the benefits are. So our clinicians aren’t having to just come up with that out of thin air or remember it, memorize from our protocol. So we’ve got, basically, an education sheet that’s right in front of them that they can be giving to the patient as they go through it.” (Clinic 18, Model 3)
Availability of health educators/support staff	“The medical assistants are well informed. And our medical assistants do a lot of the education for our patients and counseling for our patients. ” (Clinic 14, Model 3)
Staff PrEP training and education	“I mean, I know a lot about HIV. I’ve been here a while, but some of the other staff wouldn’t, and I think that all the nurses in this clinic should be at least trained if we did implement this, to know what it’s about.” (Clinic 8, Model 1)
Step 3: Lab Assessment for PrEP Eligibility
Access to laboratory	“In terms of testing for kidney function, hepatitis, those are send out tests. So we can draw blood right there in the clinic. We don’t have to send [patients] out to get their blood drawn. We’ll draw it, and we’ll send it off [to external lab].” (Clinic 22, Model 3)
Staff training and education on lab tests	“We talked to the lab and then we did a training amongst ourselves after we got that information. The rest of the tests - they’re easy. We all have had to take classes for the HIV so we all know how to do that test and the other ones you just draw the blood in the proper tube and it goes to the state. The BMP [Basic Metabolic Profile] was the only thing different that we hadn’t been doing. And since that goes to a private lab the state doesn’t do it, we just had to learn to process.” (Clinic 22, Model 3)
Funding for lab tests	“And then, if we’re gonna do lab tests, we would have to know who’s gonna pay for that. Like, in our Title X funding, I’m not sure the Title X grant is gonna pay for that. We do have the [CLINIC] system to back us up, but then they have to have a separate financial assessment to be eligible for what they’re gonna pay for their labs. We have a lab here that they could just walk next door and get their blood drawn, but who’s gonna pay for that?” (Clinic 4, Model 1)
Step 4: Prescribe PrEP
Funding for PrEP prescription	“The thing that’s made it easy for us is just the state paying for it [PrEP prescriptions] for one thing and it being free to the patients and having the PrEP coordinator too has definitely helped too. We don’t have to deal with any insurance rejections or denials or anything of that sort and we don’t have to deal with copays because everything is basically free. I don’t think it will always be that way. I think that eventually, they’re [the state] gonna run out of money or they’re gonna decide that they should bill patients that have insurance or something like that. But right now and ever since we’ve started doing PrEP, it’s been this way that everything is free, including all the lab tests too. So we haven’t really had any barriers, any significant barriers to implementing it.” (Clinic 16, Model 3)
Insurance navigators	“We have an eligibility department that, once they call in, we screen them first before they come in to see, you know, what they’re coming for and what, if they have insurance. And once we do the over the phone screening, then they—when we find out they don’t have insurance, then we’ll set them up an appointment with eligibility and then they will sit with them prior to the doctor and, you know, I guess bring in certain paperwork like proof of income, proof of residency, photo ID and whatever else they may need.” (Clinic 15, Model 3)
Step 5: PrEP Monitoring
Clerical scheduling staff	“Mainly just appointment reminders, clerical staff to help with that, sending out appointment reminders and calling patients to remind them of appointments and that sort of thing.” (Clinic 16, Model 3)
Automated scheduling/appointment reminder systems	“We have an appointment reminder system, like an automatic call. They made their appointment and then they missed it and so that will prompt the system to say, “Hey, you’ve missed your appointment. Please call and reschedule.” (Clinic 20, Model 3)