(O-G4) Emergency Department (ED) Patients’ Perspectives on Offering Pre-exposure Prophylaxis (PrEP) in the ED

Objectives: To understand ED patients’ perspectives on approaches to offering PrEP in the ED.

Background: HIV pre-exposure prophylaxis (PrEP) remains underutilized in the United States. Emergency Departments (EDs) can be strategic locations for identifying PrEP-eligible individuals and initiating PrEP because they serve people who often lack a regular source of healthcare and are at disproportionate risk for HIV infection due to intersecting social-structural vulnerabilities. However, no successful models of ED PREP have been identified. We qualitatively examined ED patients’ preferences regarding options for organizing PrEP services in the ED.

Methods: From a large, urban (NYC) ED, 15 non-acute patients who met PrEP sexual- or injection-risk behavior criteria were recruited for semi-structured interviews. Audio or video-assisted interviews were conducted at a convenient time after the ED visit. Participants discussed their overall response to being offered PrEP services in the ED, and their preferences for specific components (Figure 1, e.g., PrEP information given to all vs. targeted to higher risk individuals; Who presents the information/conducts screening; Timing in the ED visit for information/screening; Education via video, pamphlets or in-person; Immediate initiation of PrEP vs. referral; Location of follow-up). Interviews were audio-recorded and transcribed. Content coding was conducted within each topic.

Results: Of 175 patients screened, 57 were eligible, 52 agreed to and 15 completed interviews. Most participants (9 of 15) were < 40 years old; 11 identified as male; all had medical insurance, and 8 reported 1 ED visit in the past 6 months. Most (12/15) were willing to learn about PrEP in the ED if it did not disrupt their visit and they were not in distress or pain. Benefits of universal PrEP education included reducing stigma and reaching people less likely to know about PrEP, whereas targeted education would identify people most likely to respond favorably. Preference for a person (vs. video or pamphlet) to explain PrEP was high (11/15). Preferred timing was after the patient’s main concern was addressed. The importance of privacy during screening/education emerged as a priority, as did being able to speak with a PrEP expert (either clinical and non-clinical). Six opted for PrEP initiation in the ED, 4 preferred a script to be sent to their pharmacy, and 6 preferred initiation at a follow-up site.

Conclusions: Patients are willing to hear about PrEP in the ED. Benefits identified included reaching people without other access and “laying the groundwork” for PrEP. Key concerns were whether people would be able to focus on PrEP in an emergency setting, not delaying care, and not stigmatizing individuals. Offering PrEP in the ED has the potential to expand access. ED-PrEP models need to be designed and tested.

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Funding (Optional): N/A