Practicum Highlight: Eric Strauss, MA, MPH'23

Barriers and Facilitators to Uptake of Pre-Exposure Prophylaxis (PrEP) Among Black Men Who Have Sex With Men (BMSM) at an Infectious Disease Clinic in Delaware County, Pennsylvania.

Human Immunodeficiency Virus (HIV) remains a significant public health threat in the United States, particularly among Black men who have sex with men (Black MSM). However, uptake and persistence of Pre-Exposure Prophylaxis (PrEP) among Black MSM is suboptimal. While studies have examined barriers to PrEP uptake nationally, few studies have examined clinical-level PrEP programs and interventions designed to improve PrEP uptake among Black MSM. In his practicum work, Strauss highlighted structural-level factors that impact PrEP update and persistence in a clinical setting.

“It was interesting to see how poverty, stigma, marketing, etc., all contribute to the overall success of PrEP uptake and adherence (which is a key component of the national strategy to end the HIV epidemic). HIV is still a genuine problem in the US. While on a national level, indicators are improving, in certain populations (Black Men Who Have Sex With Men, particularly in the Southern US), HIV is getting much worse.”

Strauss evaluated barriers to the uptake and persistence of PrEP through a program analysis of an existing PrEP program at a community-based infectious disease clinic, AIDS Care Group. Both qualitative topics (processes, challenges, barriers) and quantitative topics (demographics, HIV risk, persistence) were examined. The literature review focused on PrEP and HIV among Black MSM. Change ideas were developed using the Model for Improvement. As the Executive Director of AIDS Care Group, Strauss reflects,

“Dartmouth was instrumental in equipping me with the tools needed to understand and synthesize the academic thinking on HIV and PrEP. In addition, my training allowed me to take that information and apply it locally, focusing on improvement methods to increase the success of a PrEP program at my organization.”

​​Structural-level issues such as stigma, homophobia, and poverty were identified as the primary barriers to PrEP uptake nationally. These barriers were also identified for AIDS Care Group patients, with some newly identified issues like pill burden and insurance continuity. PrEP awareness was moderate at both the national and clinical levels. PrEP persistence at AIDS Care Group was higher (7.2 months) than the national average (4.7 months). Four clinical-level ideas for program improvement were developed: offering tele-PrEP, providing PrEP education to local primary care providers, employing community health workers for PrEP outreach, and training staff on motivational interviewing and adherence counseling.

Strauss is now the Executive Director of AIDS Care Group. “The lessons learned at Dartmouth have prepared me to lead a community-based safety-net organization that focuses on providing quality and compassionate clinical and supportive services to marginalized, underserved populations.”

Written by: Mia Pennekamp Soucy

POSTED 4/29/2024 AT 01:43 PM IN ##practicum