The Iowa Department of Public Health 
(IDPH) provides a coordinated, statewide HIV Pre-exposure Prophylaxis (PrEP) program, featuring care in both clinics and through telemedicine. Iowa has 99 counties, and 74% of all HIV cases are located in 10 counties, which are not contiguous or centralized around a major metropolitan area.
TelePrEP
TelePrEP consists of telemedicine video conference appointments with a dedicated PrEP clinical pharmacist who works with a supervising physician. A physical exam is not needed for a PrEP prescription. During a TelePrEP visit, a clinical pharmacist talks with the patient about their sexual and medical history, views lab work, and prescribes the PrEP medication. Pharmacists also counsel on medication adherence, birth control, and sexually transmitted infection (STI) prevention.
To participate in TelePrEP, patients must use an application on a smartphone, computer, or tablet. The app works on Iowa’s low-broadband networks. Patients receive a link for a video appointment every three months while on PrEP for follow-up tele-visits. Through use of TelePrEP, IDPH program’s providers can conduct appointments on weekends and evenings to improve access and convenience.
In its first year, the program reached an active caseload of 100 patients (all PrEP navigation outcomes). 600 people were referred to the program; 250 were referred in the second year.
Outreach & Referrals
IDPH operates a website and hotline for state-wide referrals for HIV testing and PrEP. The program markets its services to consumers, and interested patients can self-refer via the website or hotline, or medical practitioners can refer them. A patient navigator assists with benefits and referrals for testing. Patients can request an at-home self-test kit or go to a lab for initial and follow up laboratory testing. Depending on the patients’ location, IDPH can refer patients to publicly-funded health centers for testing and lab work. The patient navigator helps patients make an appointment at a clinic for PrEP in-person, or patients can enroll in the TelePrEP program. Two HRSA-funded health centers Siouxland Community Health Center and Primary Health Care, Inc., are subgrantees of the state’s program and provide outreach, testing, and PrEP to clients who are referred from IDHP.
Planning and Funding
A community assessment identified needs and barriers that informed creation of the TelePrEP program. The program addresses transportation, stigma, and privacy barriers to care. The team met frequently each week for the first year to continuously improve the model.
The savings from HRSA’s 340B Drug Pricing Program is used to pay for the TelePrEP providers as payer reimbursement for telemedicine is currently limited in Iowa. The IDPH team includes University of Iowa Hospitals and Clinics providers, three clinical pharmacists doing TelePrEP, a sustainability manager, and the patient navigator.
