Cook County Health & Hospitals System ( CCHHS ), on Sept. 15, announced an initiative to increase access to pre-exposure prophylaxis, or PrEP, for its patients.
The new program funds staff in additional locations on the city's West Side, along with CCHHS' Ruth M. Rothstein CORE Center, to assist patients in obtaining PrEP, an intervention, usually available as the oral medication Truvada, that significantly diminishes the risk of HIV infection. Patients who begin PrEP will be able to see doctors at those locations for follow-up visits and care for other conditions.
The CORE Center received funding from Chicago Department of Public Health ( CDPH ) in early 2015 to create a PrEP program, but officials determined the scope of those initial efforts were too small, said David Schwartz, M.D., infectious diseases division chairman for CCHHS.
"It started small, one half-day a month, and expanded to three half-days a month," said Schwartz. "This experience was good. It got a lot of people into PrEP. It did not get the numbers as hoped though. Part of the problem was there were not a lot of time slots available. If you're a busy person, you may be working or have other things going on [at those times]. So that was an obstacle."
Schwartz said other obstacles for potential PrEP candidates included working around the the high cost cost of the medication, navigating the county health system logistics and deciding whether or not to take a medication for preventative purposes.
Earlier in 2016, CDPH obtained additional money from the Center for Disease Control and Prevention to expand the program to make PrEP more available to Chicagoans on the West and South Sides. CCHHS used that funding to expand access to two West Side locations, Austin Health Center, 4800 N. Cicero Ave., and Jorge Prieto Family Health Center, 2424 S. Pulaski Rd. The CORE Center, 2020 W. Harrison St., has also expanded its PrEP clinic hours to five days a week at 9 a.m.-3 p.m.
"These are clinics that do general medicine, but the money from the grants is paying for a project coordinator for both sites, and a navigator at each site, whose job it is to help people get started on and maintain PrEP," Schwartz said.
CCHHS provided medical personnel at those clinics with the training to administer PrEP as well. It also expanded the PrEP services at the CORE Center, so that individuals could inquire about it at its walk-in clinic every day. Furthermore, those using the clinic would not be billed for that first visit, at which time staff could help determine whether private insurance, Medicaid or other means could pay for subsequent appointments. Schwartz noted that lab tests for that first visit would also be free.
"Another problem is that when people came in for PrEP, it was just for PrEPthe visit didn't address the other needs of HIV-negative, high-risk people," Schwartz added. CCHHS will now make a concerted effort to get those individuals on their own continuum of care, so providers can address other chronic health conditions or mental health issues, for example, as they arise. Schwartz said that both the CORE Center and the West Side clinics could serve as both gateways and destinations for care for persons seeking PrEP.
"PrEP should not be PrEP and nothing elseit should be part of comprehensive medical care," he added.
Provident Hospital of Cook County, 500 E. 51st St., also obtained funding in the CDPH PrEP initiative. "They hadn't done PrEP previously on a consistent basis, so they are stepping that up," Schwartz said.