HIV Specialist - March 2021 - 32

Number of Diagnoses of HIV Infection in the United States, 2017
9,000
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0

13-14

15-19

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

65+

Statistics Overview | Statistics Center | HIV/AIDS | CDC, (n.d.) Retrieved August 28, 019, from
https://www.cdc.gov/hiv/statistics/overview/index.html

Significant racial and ethnic disparities in PrEP use
100%
90%

95%

80%

87%

86%
■ White MSM

70%
60%

■ Hispanic MSM ■ Black MSM

58%

50%

44%

40%

43%

30%

42%
30%

20%

26%

10%
0%
PrEP awareness

Discussed with provider

PrEP use

Kanny D, Jeffries WL IV, Chapin-Bardales J, et al. Racial/Ethnic Disparities in HIV Preexposure Prophylaxis Among Men Who
Have Sex with Men - 23 Urban Areas, 2017. MMWR Morb Mortal Wkly Rep 2019;68:801-806.

Our experience caring for teens and young adults has taught us the
importance of three concepts that must be in place to have successful
interactions on any subject, but especially with sexual health:
1. Trust. The basic tenet of working with adolescents is establishing
trust first; action and implementation will follow. But this takes
time and patience. Repeat follow-up visits with the same provider
can foster this.
2. Confidentiality. Adolescents and young adults won't trust providers unless they know for certain that the information they share
about themselves will not be shared with anyone else.
3. Access. Texting/messaging is generally preferred. Our patients
prefer to send us a quick secure message through our online portal
that we can respond to quickly.

32

MARCH 2021

HIVSPECIALIST

WWW.AAHIVM.ORG

Telehealth addresses need for
trust and confidentiality

We turned to telehealth and virtual visits
as a solution to meeting the needs of our
adolescent patient population. Our efforts
started before the SARS-CoV-2 pandemic,
and though virtual visits were increasing
in popularity, they hadn't become nearly as
robust as they are now. We envisioned utilizing a digital health platform to provide the
confidentiality that the program required.
Using a secure telehealth system, youth
from anywhere in California can now enroll
in the Stanford Medicine Virtual PrEP
Program. Once they fill out an online form,
they are connected with a pediatric or adolescent care provider specifically trained to provide sexual health counseling, recommended
lab testing, and adherence support.
Virtual visits allow our patients to
connect with us from anywhere-which has
included the beach, the middle of a shift at a
fast food restaurant, a school bathroom and a
parked car. Of course home is also an option,
but many of our patients prefer to keep their
sexual health private. Virtual visits enable
us to reach young people anywhere in the
state, from big cities with many healthcare
providers to rural areas where healthcare is
less available or more difficult to access.
Most samples for STI screening including
HIV are collected at the patient's local lab.
Extragenital sexually transmitted infection
(STI) collection materials are not often stocked
by labs, so we mail these to an address of the patient's choosing, such as a college dormitory or
a friend's house. Between visits, we use secure
messaging through our online portal.

Establish an infrastructure

One of the first steps we took to establish
our program was to create an infrastructure
that would facilitate confidential enrollment
both within and outside of our health system.
All visits and labs are flagged internally as
confidential. We also created a digital referral
system so that other outside providers could
easily send patients to our team.
Training pediatricians in how to provide
PrEP is a priority. Due to how recently PrEP
was approved for adolescents, many pediatric
providers have not been trained to prescribe
it. One additional barrier for pediatric


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HIV Specialist - March 2021

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