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Description:Integrated Pharmacy and PrEP Navigation (PN) Services is a structural intervention that integrates routine medical care with a peer navigator providing insurance navigation and an on-site pharmacy using a Plan-Do-Study-Act (PDSA) framework. A PrEP navigation tool is used to identify and decrease barriers to PrEP initiation for persons with new PrEP prescriptions. The intervention has two cycles. Cycle 1 focuses on identifying barriers to picking up initial PrEP prescriptions. Cycle 2 focuses on staff trainings and system improvements informed by patient feedback about the PN tool. In Cycle 1, the nurse practitioner (NP) follows all PrEP patients. For those who do not pick up their PrEP prescription within 7 days, the NP uses the PN tool to identify barriers to initiation. In Cycle 2, the NP continues to monitor prescription pickup rates and assesses whether patients continue to face system level barriers that were identified in Cycle 1. Cycle 2 includes an assessment of needs to improve communication among medical providers, front desk staff, pharmacy personnel, and patients. Weekly medical, community health, and pharmacy meetings are held to review patient responses and current procedures and facilitate discussion on system-level responses. Other strategies include training pharmacy staff on counseling patients about possible home delivery of refills, retraining pharmacy technicians to ask all eligible patients if they want to enroll in the pharmaceutical company copay assistance plans, and sending messages through the electronic medical record (EMR) messaging about patients who are starting PrEP and have insurance coverage concerns.
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