Bridging the PrEP Gap in Portsmouth, Virginia: A Patient-Centered, Systems-Based Approach to HIV Prevention
Poster #: 163
Session/Time: B
Author:
Bailey Josephine Steelman, BS
Mentor:
Kavita Imrit-Thomas, DO
Research Type: Public Health
Abstract
INTRODUCTION:
HIV continues to pose a significant public health challenge in Portsmouth, Virginia, where the prevalence is more than twice the state average. This project aimed to increase the uptake of HIV Pre-Exposure Prophylaxis (PrEP), which is a highly effective way to prevent HIV acquisition by creating community-informed training after investigating key barriers to PrEP utilization. Historical and structural barriers to PrEP utilization were examined, including stigma, low awareness, health literacy, and staff discomfort. In addition, systemic challenges such as limited staff training, fragmented infrastructure, and collaboration between public health entities and academic institutions. This project used an interdisciplinary training effort grounded in implementation science and stakeholder engagement. The timing of this project is critical, given the current uncertainties in preventive medicine and HIV.
METHODS:
The project was conducted at the Portsmouth Health Department (PHD), which serves high-risk populations through programs including Sexually Transmitted Infections (STI), Maternity, Family Planning, School Physicals, Immunizations, Refugee Health, Harm Reduction, and Woman Infant and Children (WIC) etc. Structured interviews were held with patients, PHD staff, leadership, PrEP navigators, and community partners to identify barriers and inform intervention design. A three-module PrEP education and stigma-reduction training was delivered to 20 multidisciplinary staff, including clinical, administrative, and public health professionals. Each module addressed PrEP basics, access pathways, and inclusive patient communication, with clearly defined learning objectives. A 12-question pre- and post-training survey assessed changes in knowledge (via four multiple-choice questions) and comfort with PrEP-related discussions (via four Likert-scale items). Descriptive analysis was used to evaluate outcomes. The training was based on implementation science, quality improvement methodologies, and high-value care principles, with a focus on process adaptation and potential scalability.
RESULTS:
Of the 20 participants, 19 completed both the pre- and post-surveys. Among 18 who completed knowledge-based questions, the average scores increased from 77.6% to 94.4%. Seventeen staff completed the Likert-scale questions measuring communication confidence, with mean scores rising from 14.8 to 17.4 out of 20. The most significant gains were in self-perceived knowledge and the ability to use inclusive language. Feedback revealed increased confidence, appreciation for new tools, and enthusiasm for continued training. One STI staff member shared, "This helped motivate me with my interview techniques and word usage." Another participant emphasized learning "how to have the tough conversations with patients." Staff across departments expressed interest in integrating PrEP education into their existing services, reflecting broad relevance and buy-in across PHD.
CONCLUSION:
This targeted, multidisciplinary intervention led to measurable improvements in PrEP-related knowledge and communication confidence among staff in a high-burden, resource-constrained public health setting. By addressing stigma and system-level barriers through patient-centered training, the initiative enhanced health department readiness to deliver equitable HIV prevention services. Most importantly, this project laid the foundation for a sustainable public health-academic partnership aimed at eliminating HIV transmission in Portsmouth. It serves as a replicable model for integrating HIV prevention into routine services and building collaborative infrastructure to achieve long-term community impact aligning with CDC's Ending the HIV Epidemic goals: 95% diagnosed, 95% on treatment, and 95% virally suppressed.
HIV continues to pose a significant public health challenge in Portsmouth, Virginia, where the prevalence is more than twice the state average. This project aimed to increase the uptake of HIV Pre-Exposure Prophylaxis (PrEP), which is a highly effective way to prevent HIV acquisition by creating community-informed training after investigating key barriers to PrEP utilization. Historical and structural barriers to PrEP utilization were examined, including stigma, low awareness, health literacy, and staff discomfort. In addition, systemic challenges such as limited staff training, fragmented infrastructure, and collaboration between public health entities and academic institutions. This project used an interdisciplinary training effort grounded in implementation science and stakeholder engagement. The timing of this project is critical, given the current uncertainties in preventive medicine and HIV.
METHODS:
The project was conducted at the Portsmouth Health Department (PHD), which serves high-risk populations through programs including Sexually Transmitted Infections (STI), Maternity, Family Planning, School Physicals, Immunizations, Refugee Health, Harm Reduction, and Woman Infant and Children (WIC) etc. Structured interviews were held with patients, PHD staff, leadership, PrEP navigators, and community partners to identify barriers and inform intervention design. A three-module PrEP education and stigma-reduction training was delivered to 20 multidisciplinary staff, including clinical, administrative, and public health professionals. Each module addressed PrEP basics, access pathways, and inclusive patient communication, with clearly defined learning objectives. A 12-question pre- and post-training survey assessed changes in knowledge (via four multiple-choice questions) and comfort with PrEP-related discussions (via four Likert-scale items). Descriptive analysis was used to evaluate outcomes. The training was based on implementation science, quality improvement methodologies, and high-value care principles, with a focus on process adaptation and potential scalability.
RESULTS:
Of the 20 participants, 19 completed both the pre- and post-surveys. Among 18 who completed knowledge-based questions, the average scores increased from 77.6% to 94.4%. Seventeen staff completed the Likert-scale questions measuring communication confidence, with mean scores rising from 14.8 to 17.4 out of 20. The most significant gains were in self-perceived knowledge and the ability to use inclusive language. Feedback revealed increased confidence, appreciation for new tools, and enthusiasm for continued training. One STI staff member shared, "This helped motivate me with my interview techniques and word usage." Another participant emphasized learning "how to have the tough conversations with patients." Staff across departments expressed interest in integrating PrEP education into their existing services, reflecting broad relevance and buy-in across PHD.
CONCLUSION:
This targeted, multidisciplinary intervention led to measurable improvements in PrEP-related knowledge and communication confidence among staff in a high-burden, resource-constrained public health setting. By addressing stigma and system-level barriers through patient-centered training, the initiative enhanced health department readiness to deliver equitable HIV prevention services. Most importantly, this project laid the foundation for a sustainable public health-academic partnership aimed at eliminating HIV transmission in Portsmouth. It serves as a replicable model for integrating HIV prevention into routine services and building collaborative infrastructure to achieve long-term community impact aligning with CDC's Ending the HIV Epidemic goals: 95% diagnosed, 95% on treatment, and 95% virally suppressed.