Assessing the role of local health departments in implementing PrEP in the US, 2020 update

Objectives To identify current and potential roles for, and systematic barriers encountered by, local health departments (LHDs) engaging in PrEP implementation. MethodsWeb-based assessment created with Qualtrics(R) from Oct.-Dec. 2020 distributed via e-mail to 1,096 LHDs that indicated they provided HIV or STD screening and/or treatment in NACCHOs 2019 National Profile of Local Health Departments. ResultsOf 354 respondents, 46% of LHDs were engaged in PrEP implementation compared with 29% in 2015. Activities included: referring to PrEP providers (68%); conducting consumer education (65%); promoting PrEP (59%); educating providers; (48%); and prescribing PrEP (42%). The top challenges to initiating or expanding PrEP implementation were lack of funding and staff, and 41% described staff reductions during COVID-19. ConclusionsLHD engagement in PrEP implementation has increased significantly since 2015 but many LHDs still encounter barriers to initiating or expanding PrEP activities. Policy ImplicationsRobust funding of public health infrastructure can ensure that LHDs and their partners are equipped to provide PrEP access for all who may benefit from it during future public health emergencies.