Funded Projects

LinkED 2 PrEP

Project Year

2025

City & State

Washington, District of Columbia

Program Name

CATCH Planning

Topic

HIV

Program Description

Problem: Pre-Exposure Prophylaxis (PrEP) is highly effective at preventing transmission of Human Immunodeficiency Virus (HIV) and has been FDA approved for adolescents since 2018. However, the utilization of PrEP remains low. Compared to other age groups, PrEP use is disproportionately low among ages 13 through 24 years, who represent approximately 20% of all new HIV diagnoses in U.S. but only 12% of PrEP users. Furthermore, significant racial and ethnic disparities in PrEP use exist; for example, PrEP-eligible Black and Hispanic youth are less likely to be on PrEP than their non-Hispanic White counterparts.  Adolescents frequently use the Emergency Department (ED) for primary care concerns; including for sexual health. Consequently, ED visits are a unique opportunity for some preventative health interventions. Currently, clinicians at the Children’s National ED can make referrals to the hospital PrEP clinic, but these referrals seldom result in initial clinic visits, representing a missed opportunity to provide quality and potentially lifesaving care.  Primary Setting: This will take place in three settings: the Children’s National ED in DC, the HIV Prevention and Treatment (HPTS) Youth Advisory Board (YAB), and within three local DC community health organizations that work with adolescents.  Number of Children Affected: In 2022 there were 6,400 new HIV diagnoses among ages 13-24 years in the US, according to the CDC. In Washington, DC, the primary service area for the CNH ED, the rate of new HIV diagnoses among this age group is the single highest in the country at 43.6 per 100,000 people. The exact number of children who are potentially PrEP eligible is unknown, but a study in the CNH ED suggests that nearly 27% of all adolescents seen in the ED are potentially PrEP eligible. This further suggests the ED is an important venue to reach PrEP-eligible adolescents.  Project Goal: Obtain community input on strategies to improve the linkage of PrEP care from the CNH ED to PrEP clinics in the hospital and community. The project will be called LinkED 2 PrEP.  Proposed Intervention 1) Conduct structured interviews with ten adolescents from the YAB regarding their utilization of the ED for sexual health services, preferred information modalities on PrEP, and preferences on how to best implement ED based referrals to PrEP clinics 2) Conduct structured interviews with representatives of three community organizations, such as Whitman-Walker Health Clinic, the Sexual Minority Youth Assistance League (SMYAL), and the DC Latin American Youth Center (LAYC) to solicit input on how to effectively refer adolescents to PrEP care 3) Qualitatively analyze these interviews to develop a list of potential ED based referral interventions, such as text follow-ups, call follow-ups, self-referrals, etc. and then survey fifty adolescents seeking sexual health care in the ED regarding these potential referral modalities 4) Discuss these results with the community partners and the YAB to develop community-guided and adolescent tested strategies to better refer adolescents for PrEP care from the ED to hospital or community-based clinics. 5) Finally, share these strategies within the CNH ED and CNH PrEP clinic to develop an integrated approach to PrEP referrals.  Of note: A consultant will conduct the interviews and subsequent analysis and assist with survey development. ED research assistants will administer the surveys.  Anticipated Outcomes: The outcome from interventions one & two will be a qualitative analysis used to create a list of potential referral modalities. Input on which will be obtained from surveys of fifty adolescents in the ED. Then, in conjunction with the initial YAB and community organizations, the results of these surveys will be used to develop a toolkit for ED based PrEP referrals that is patient centered.

Project Goal

Obtain community input on improving the linkage of PrEP care for adolescents from the CNH ED to PrEP clinics in the hospital and community and develop strategies to improve linkage from the ED to PrEP care.

Project Objective 1

Interviews: In the first two months, from June to July 2025, the project will conduct structured interviews with ten members of the Children’s National HIV Prevention and Treatment Services Youth Advisory Board, specifically including members of populations that are historically underserved and/or disproportionately affected by the burden of HIV including members of the LGBTQ+ community, Black and Hispanic adolescents, and people who speak Spanish. Additionally, the project will conduct three structured interviews with representatives from Whitman-Walker, SMYAL, and the DC Latin American Youth Center.

Project Objective 2

Surveys: In the next six months, from August 2025 to January 2026, the project will perform a qualitative analysis of the adolescent and community organization representative interviews and use this analysis to generate an ED based survey on potential PrEP referral approaches.  The project will administer this survey to 50 adolescents seeking STI care in Children’s National Emergency Department.  The survey respondents will include members of the LGBTQ+ community, Black and Hispanic adolescents, and people who speak Spanish.

Project Objective 3

Toolkit Development and Dissemination: In the final four months, from February to May 2026, the project will analyze the ED survey results, discuss these results with the YAB and community partners, develop a toolkit of PrEP referral strategies, and share the strategies with CNH ED providers and PrEP clinics.

AAP District

District III

Institutional Name

Children's Research Institute

Contact 1

Nicholas Dimenstein, MD, MPH

Contact 2

Eric Rosenthal, MD, MPH