Incorporating PrEP and PEP into school-based health centers

Transcript:

Natasha Hoyte, MPH, CPNP-PC:

Hi my name is Natasha Hoyte. I am a pediatric nurse practitioner, affiliated with New York-Presbyterian School Based Health Centers. I love NAPNAP. I've been a member of NAPNAP for quite a few years now and I love the fact that there are so many sessions, so many opportunities for me to network with colleagues, as well as to be able to learn some of the information that people are sharing from across the country. Really what brought me to this particular session was now that I am a nurse practitioner working in school-based health, I see the need for expanded sexual and reproductive health services. My co presenter Alley Dionne-Claycomb, CPNP-PC, and I, got together and we decided to discuss PrEP, pre-exposure prophylaxis, post-exposure prophylaxis, really getting it out there to the young people that we serve. There are over 2500 school-based health centers in the United States, most of which are located in underprivileged underserved areas. Where we work in New York City is one of those areas. So really being able to show and showcase what we do, give our knowledge and our experiences over to other nurse practitioners who may be able to also implement PrEP and PEP in their schools.

PrEP is not new, it [was] approved by the FDA for minors in 2018. However, there are across many different school based health centers, there's varying degrees and comfortability, and who's prescribing and how it's being rolled out. At our particular institution, we do have access on site that we are able to offer to students both PrEP and PEP. A lot of it just comes down to empowering the nurse practitioners and other people who are working in school-based health centers, clinicians, and to be able to identify who's eligible for PrEP, being able to have those conversations around HIV-prevention services, being able to talk comfortably about what PrEP actually is. So you're looking at the medications, you're looking at the risks, the benefits, generally speaking, PrEP is pretty safe for youth and so just being able to get the word out, the message out that this is something that anyone can do. You do not need to be a specialist, as a provider, you don't have to work in the emergency room, really, for any primary care provider and someone working in school based health, as long as you have the tools and you're knowledgeable about it, go ahead and and prescribe it. So really just making sure that people are aware that the medication exists, knowing the indications for it, knowing how to prescribe, manage, and also just have that conversation with the patients about maintaining safety.

We know that youth, a word of mouth goes a very long way and so even if we can reach one youth and just share our experiences with them, they are more likely to talk to their peers. In our program, we do have health educators and we have peer educators. So the teens that are in our program, they do get the information, and they're more likely to spread it with their other peers. Being able to get them on board this is a part of their sexual health. We want them to be safe, we want them to have buy in and input. It is their bodies, and we want them to be mindful and comfortable with what they're putting in their bodies. So the medications that we do offer for PrEP, just making sure that they're aware of the options that are available to them so that they can safely take their medication. So I would absolutely say just spreading the word out to young people PrEP is here, PrEP is available should you need it before an exposure, after an exposure, being able to identify when the best time to take it and to start. Just encouraging them to have that dialogue with the medical provider.

There is a preferred time. We know that there are HIV infections that occur, about 20% of new HIV infections occurred in 2020, between the ages of 13 to 24. So the sooner we can talk about PrEP, the better. We would argue even in our health-based centers, we are talking with high schoolers, even middle schoolers about it just so that they can be aware that this exists. So we would say the earlier the better, even before someone is sexually active, just making sure they know that prep is available PEP is available, should they need it, just so that they can be more prepared, because what we want to see is that the the newer infections are reduced. So the earlier we get the word out, then the more people are empowered and equipped to make that decision.

Majority of the time these youth are really interested. Most of them don't know, have not had that discussion with anyone prior to and so that's also a great plug for the school-based health is to just supplement and complement the information that they're receiving from their primary care providers around sexual health. But certainly, there is that relief of knowing like, "wow, I didn't know this, that medication existed, can you tell me more about it." And even if they may not start that day, at least that conversation has started so that in the future, they can reopen the conversation with a medical provider.

I would just like to encourage any medical provider to really have the discussions with their patients about PrEP and PEP. We also know that across racial and ethnic groups, there is a disparity in who's actually being prescribed to PrEP. So less than one quarter of Black and Hispanic patients have actually been prescribed PrEP. And this is for people who actually need the PrEP, compared to three quarters of Whites. So we also see that racial and ethnic disparity and we also see that occurring among genders. We know that based on data from the CDC that males have been 3-times more likely to be prescribed than females, and yet we know that adolescent girls and young women still need HIV prevention. Really just making the bar even across all playing fields, so having that discussion earlier with everyone can really help.

For more NAPNAP coverage, click here.