Table 1 Strategies for lowering barriers to PrEP access identified in interviews and exemplar quotes

Conducting Community Outreach

Prepare patients to be active participants

In-person outreach, especially for young adults

“Even at college events, I feel like students are more comfortable at those events. They’re like, ‘Hey, I actually never heard of PrEP,’ and then they’re like, ‘Oh, I’m comfortable in this setting,’ rather than being inside an office or, like, in a lab room, talking about it.” (Prevention Navigator)

Building External Collaborations

Develop academic partnerships

Leveraging resources and education from pharmaceutical representatives, researchers, and clinician partners to enhance PrEP awareness.

“A very consistent strategy that we’ve been using is collaboration with pharmaceutical companies that provide PrEP... They’ve not only been offering these presentations for the staff. They’ve been offering them for clients as well... and I know we collaborate with [local healthcare system] and their research team a lot, but we need to start collaborating with them on the level of them educating the clients or showing them what they found through their research” (Prevention Navigator)

Promote network weaving (external)

Collaboration with other community organizations to leverage collective resources.

“Sometimes it’s nice to collab. If one org has something that can help this community in another way, and then we can help related to testing in HIV and PrEP.” (Prevention Navigator)

Providing Co-located Resources and Services

Change service sites

One-stop-shop for services

“Not just sexual health, but they have education. They have a college here. They have other resources. They have a GED program. They have CDL. You know, there’s so much other things that [agency name] had refocused, I believe, throughout the years to make sure that they’re client-centered.” (Prevention Navigator)

In-house pharmacy and using home-delivery services through outside pharmacies

“At the end of the day, it’s not like a pharmacy when you go to Rite Aid, and they’ll be like, ‘Hi. Okay. You’re done.’ No. They’re, like, ‘Oh, hola, [removed]. How are you?’ You know? They interact. They get to know you because these people have been coming, getting their prescription for years. So they feel at home within the pharmacy that’s inside [agency name].” (Prevention Navigator)

Providing services from a Mobile Treatment Unit.

“We’re not the only people with mobile vans, there’s 10 of us now in Philadelphia... It’s just a helpful thing to get us to the people are the most vulnerable and underserved.” (Agency Leader)

Promote network weaving (internal)

Close partnership between prevention team and onsite clinic

“Because us, we’re here, and when we get people connected-since our clinic is right next door- you don’t have to travel down the street, or you don’t have to catch another bus or anything. You could get the insurance from us and then if you have any questions, we’ll answer it with you when we’re signing up. And then whenever you get approved, you don’t even have to come to [the prevention team] anymore. You can just go to the clinic. Or, if you wanna do a same-day appointment, we just call the clinic and we can walk you over.” (Prevention Navigator)

Integrating PrEP into Clinical Services

Revise professional roles

Using an education specialist to provide in-depth information about PrEP for individuals and groups

“Now we have funding for this [education specialist], which makes it better. Because we always said that this was the missing component because, we did educate them but we couldn’t document it. You know, we could document in our reports but we couldn’t go into depth about what was discussed and so forth like that. Now on the other hand it’s different.” (Prevention Navigator)

Addressing social needs through integrative medicine

“I think this is the problem in scaling up PrEP... if you peel it off and give it to some peripheral person, most of the clinicians aren’t talking about it, thinking about it, engaged in it, engaged with the patients and dealing with it, helping the patients deal with it. See how it inter-relates to other things. So integrative medicine is what we do and what we’re here for... I think it is key. (Agency Leader)

Remind clinicians

PrEP integrated into forms and protocols, prompting conversation.

“I think integrating [PrEP into the intake paperwork] has been helpful, because it gives them a chance to talk about it, and you have to explain what it is, because I think a lot times we notice that people were just saying, ‘Would you like to start PrEP?’ And the patient would say, ‘No’ but there was no like education on what it was.” (Prevention Manager)

Increasing Staffing Resources and Capacity

Recruit, designate, and train for leadership

Hiring staff from within the communities being served

“I think [agency name] actually does a great job of when they’re interviewing folks of trying to find folks that are part of the community that we are trying to serve. So, instead of trying to reinvent the wheel, if we’re looking to reach out to MSM and trans folks, not hiring a cis person to work directly with those populations.”(Prevention Navigator)

Facilitate relay of clinical data to providers

Reporting metrics around PrEP goals to team

“We have monthly staff meetings so that’s how we get updated, I mean, ‘cause we’re the testers but we can’t always know exactly the numbers. So, usually our supervisors will, after we give them our report, they’ll put it into their report to submit and then when we have a staff meeting, we report back to everybody like on a monthly basis how we’re doing.” (Prevention Navigator)

Addressing Client-Level Barriers

Intervene with patients to enhance uptake and adherence

Motivational interviewing

“We believe that motivational interviewing is a key strategy that really everyone who has any role in patient care should be using... there’s exponentially more research supporting motivational interviewing than any other psychosocial intervention anywhere, right? And so if there’s one thing we should all be focused on, it’s this.” (Agency Leader)

Linking uninsured or undocumented clients to patient assistance programs.

“Then it’ll come up, ‘Well like, I don’t have insurance,’ or, ‘Is it a copay involved?’ Like, ‘How am I gonna pay for this?’ Right? And it’s something like, ‘Oh, don’t worry about it. We’ll cover it. Like, it will be nothing to you.’... not only do we have that assistance program that covers the PrEP medication and the PrEP appointments, this particular grant has some money that will also cover labs.” (Prevention Manager)

Opt-out PrEP services.

“…we have been starting to implement kind of an opt-out rather than an opt-in process. So, when we do get a new patient, we kind of say that as of a blanket, for all of our patients we do rapid HIV bloodwork and a urine STI screening. Which they can decline if they want to, but, usually they don’t. And then we can talk to them about the services, like PrEP and that kind of stuff, and have them decline getting it rather than saying ‘Oh, yeah, I do want that.’” (Prevention Manager)

Offering PrEP information to all clients.

“We’re not known for testing like just LGBT people, we’re not known for just testing women, we’re not known for just testing men. We test anybody who walks through the door for everything. I think that’s a great benefit in the sense of we’re not telling people anymore that, ‘Oh no, we’re just trying to get MSM or trans folks on PrEP.’” (Prevention Navigator)

Incentives for HIV testing and PrEP maintenance (client-level)

“The current clients, they come back for their gift cards and their key passes, and then they get their meds. So, they’re going to remember, like, ‘Oh, if I don’t get my meds, then I won’t get this.’” (Prevention Navigator)