AIDS and Behavior

, Volume 23, Supplement 3, pp 296–303 | Cite as

PrEP Implementation and Persistence in a County Health Department Setting in Atlanta, GA

  • Charlotte-Paige RolleEmail author
  • Udodirim Onwubiko
  • Jennifer Jo
  • Anandi N. Sheth
  • Colleen F. Kelley
  • David P. Holland
Original Paper


For marginalized populations, county health departments may be important PrEP access points; however, there are little data on successful PrEP programs at these venues outside of incentivized demonstration projects. Therefore, we implemented an open-access, free PrEP clinic at a county health department in Atlanta, GA to promote PrEP uptake among high-risk clients. The Fulton County Board of Health PrEP clinic launched in October 2015, and eligible clients who expressed interest initiated PrEP and attended follow-up visits per CDC guidelines. Clients engaged in quarterly follow-up and seen within the last 6 months were defined as “persistent”, whereas clients with a lapse in follow-up of > 6 months were defined as “not persistent.” Factors associated with PrEP persistence were assessed with unadjusted odds ratios. Between October 2015 and June 2017, 399 clients were screened for PrEP, almost all were eligible [392/399 (98%)]; however, 158/392 (40%) did not return to start PrEP after screening. Of 234 patients, 216 (92%) received a prescription for PrEP. As of June 2017, only 69/216 (32%) clients remained persistent in PrEP care, and the only evaluated factor significantly associated with PrEP persistence was age ≥ 30 years (OR 1.86, 95% CI 1.02, 3.42). Implementation of PrEP in the county health department setting is feasible; however, we have identified significant challenges with PrEP uptake and persistence in our setting. Further research is needed to fully understand mediators of PrEP persistence and inform interventions to optimize health department-based PrEP services.


PrEP implementation Health department HIV prevention PrEP persistence PrEP adherence Atlanta 



We thank Diakima Thomas, and the FCBOH PrEP clinic staff for their contributions and feedback.


This work was supported by the National Institutes of Health: K23AI108335 (PI: Kelley) and K23AI114407 (PI: Sheth)

Compliance with Ethical Standards

Conflicts of interest

There are no conflicts of interest or financial disclosures for any author.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Orlando Immunology CenterOrlandoUSA
  2. 2.Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaUSA
  3. 3.Fulton County Board of HealthAtlantaUSA
  4. 4.Emory University School of MedicineAtlantaUSA
  5. 5.Division of Infectious DiseasesEmory University School of MedicineAtlantaUSA
  6. 6.Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaUSA

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