Using Telehealth for Adolescent HIV, Chronic Disease Prevention

Stanford Children's Health has launched a new chronic disease prevention virtual care program that utilizes telehealth strategies to provide comprehensive HIV-prevention services to patients up to the age of 25 in California.

The Stanford Medicine Virtual Pre-exposure Prophylaxis (PrEP) Program for Adolescents and Young Adults uses a secure telehealth system to connect patients with pediatric and adolescent care providers, called PrEP Navigators. PrEP Navigators are trained to provide sexual health counseling, labs, and medication adherence support for PrEP, a daily HIV prevention pill.

When taken correctly, PrEP is over 99 percent effective in preventing HIV. All patients who are at risk (or anticipated risk) for HIV infection are recommended to take PrEP.

In California, youth account for about 20 percent of new HIV diagnoses, however they have the lowest reported PrEP use when compared to older cohorts. Stanford Children's Health is the largest health care organization in the country that is working to address this care gap effecting young patients by specifically focusing on providing chronic disease prevention care through PrEP.

"Our mission is to improve access to quality PrEP care for adolescents and young adults," said Geoff Hart-Cooper, MD, founder and medical director of the Virtual PrEP Program. "Discussing sexual health, particularly among adolescents who may still receive care from a pediatrician, can be uncomfortable for patients and even some providers.”

“Our team of dedicated PrEP Navigators are specifically trained to provide an accepting, inclusive, and confidential environment to meet the needs of these patients and start individuals on treatment as soon as possible,” Hart-Cooper continued.

Care provided through the PrEP Program is conducted using a patient's computer or mobile device, utilizing telehealth strategies.

Hart-Cooper noted that utilizing telehealth technology for the PrEP Program eliminates the need for patients to travel to a care facility, making continued care convenient for families especially amidst COVID-19.

"Virtual care allows us to meet youth where they are, even during transition to college or other moves, and offers an added layer of confidentiality, as it allows providers to communicate with patients one-on-one, without involving a parent or other guardian if that is the patient's preference," Hart-Cooper said.

After the initial virtual intake visit, patients are mailed an at-home testing kit. Prescriptions are fulfilled at patients’ local pharmacies and ongoing labs are conducted every three months at a local clinical laboratory. Patients participate in biweekly video calls with their dedicated PrEP navigator.

This program is available to anyone 25 years or younger in the state of California whether or not they are an existing Stanford patient. In almost all situations, the cost is supplemented with funds from various patient assistance programs.

In addition to providing virtual care for patients, the program offers educational provider-training webinars that outline best practices for prescribing and monitoring PrEP to improve pediatric healthcare throughout California 

"Some providers, particularly pediatricians, may not be aware of or trained to provide HIV-prevention tools, such as PrEP, or may not have experience discussing sexual health with young patients, which can make it difficult for youth to disclose sexual behavior, or lead to concerns about confidentiality," said Megen Vo, MD, associate medical director of the Virtual PrEP Program.

"By connecting patients with providers specifically dedicated to administering PrEP support, the Virtual PrEP Program is mitigating these existing barriers to treatment, and the remote nature of the program enables us to accept youth referrals from physicians all over the state of California," Vo continued.

Minorities are disproportionately affected by HIV, according to the Centers for Disease Control and Prevention, impacting 50 percent of Black men who have sex with men (MSM) and 25 percent of Latinx MSM, compared to 9 percent of White MSM.

However, White MSM are significantly more likely to be aware of PrEP and engage in discussions about it with a provider when compared to Black or Latinx MSM. While simultaneously being more susceptible to HIV and less likely to have discussions with providers about PrEP, these racial and ethnic minorities are also most likely to be affected by COVID-19.

"Throughout the pandemic, providers have witnessed a dramatic decrease in PrEP use among new and continuing patients alike, and most commonly among minority patients younger than 26 years old," said Carrie Chan, NP, associate medical director of the Virtual PrEP Program.

"Our virtual care model can improve access to PrEP among racial and ethnic minorities, as well as provide specialized youth support, which is more critical than ever as we face the economic insecurities and health outcomes that are disproportionately affecting these groups during the COVID-19 pandemic,” Chan explained.