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City officials describe PrEP expansion effort and gaps in awareness among vulnerable groups
Summary
San Francisco City Clinic leaders described a citywide effort to expand PrEP access through navigators, ambassadors, clinical training and a new social marketing campaign; they reported program growth but notable disparities in awareness and uptake among young people and African Americans.
San Francisco City Clinic and population-health officials briefed the Health Commission on steps to expand pre-exposure prophylaxis (PrEP) for HIV prevention and on gaps in uptake across communities.
Stephanie Cohen, medical director at San Francisco City Clinic, described citywide coordination under the Getting to Zero consortium that includes city clinics, community-based organizations and major health systems. She said city clinic has initiated over 800 individuals on PrEP through a demonstration project, and that PrEP delivery has expanded to more than 30 clinics citywide. Cohen added that over 100 clinical providers and more than 50 HIV test counselors have received PrEP training and that the city has funded or supported a network of PrEP navigators embedded in community organizations.
Cohen described an outreach and social marketing push that went live the day prior to the meeting, including visible transit ads and a website (sexualrevolution.org) and a citywide PrEP navigator phone line and email for clinicians. The campaign emphasizes targeting young men who have sex with men of color and transgender women, Cohen said.
Cohen presented clinic data showing a sharp rise over 2011'016 in awareness of PrEP and in self-reported PrEP use among clinic patients. She emphasized persistent disparities: younger people (under 18), African Americans and many female patients report lower awareness; among City Clinic—s patients she said about one-third reported being on PrEP. Cohen also discussed developing a PrEP cascade (awareness -> offer -> uptake -> adherence) to target outreach and use STD/HIV surveillance to guide provider detailing and technical assistance.
In questioning, commissioners asked whether sex workers and transgender women were included in targeted outreach; Cohen said they are priorities and that separate initiatives and grants (including a transgender PrEP demonstration project) address those groups. Commissioners also raised modeling and targets: Cohen said prior modeling suggested a goal around 15,000 PrEP users to bend transmission curves, but she noted current counts are uncertain and various data sources yield a wide range of estimates for current users; at the meeting staff described a lower bound of roughly 6,000 and higher estimates from surveys that suggest numbers in the range discussed by providers.
Commissioners pressed for more data to track equity in PrEP delivery and for continued coordination of messaging and provider training to reduce STD risks in a biomedical prevention era. Staff said they will continue to refine cascade metrics and report back.
