(PL34) SUCCESSES AND LESSONS LEARNED FIVE YEARS AFTER IMPLEMENTING THE ENDING THE HIV EPIDEMIC PROGRAM AT CHEROKEE NATION HEALTH SERVICES

Background:
American Indian/Alaska Native (AI/AN) communities are inequitably impacted by HIV. In response, Cherokee Nation Health Services (CNHS) launched the Ending the HIV Epidemic (EHE) Program  in 2019. This program included a public education campaign centering on HIV care and HIV prevention; strengthened universal HIV screening and treatment among patients; and the creation of a robust Pre-Exposure Prophylaxis (PrEP) program.

Methods:
Programmatic and electronic medical record data covering years 2015 – 2023 period were abstracted and analyzed descriptively to identify lifetime HIV screening prevalence stratified by temporal, age groups, and pregnancy status trends. Additionally, data were analyzed descriptively to identify temporal and geographic trends for PrEP utilization, and number of CNHS clinics and providers dispensing PrEP medication.

Results:
Overall, lifetime HIV screening prevalence among all CNHS patients aged 13-64 years increased steadily from 46.1% in 2018 before the EHE Program launched to 73.5% in 2023. Among patients aged 13-17 years, testing increased from 10.7% to 18.1%. Comparatively, among those aged 35-64 years, testing increased from 52.6% to 83.4%. Additionally, virtually all pregnant people between 2018 and 2023 were screened for HIV. The number of total unique PrEP patients increased from 16 in 2018 to 76 in 2023; while the number of providers and locations at which PrEP was delivered increased from 6 to 21 and 3 to 9 during the same period, respectively. After implementation, geographical access to PrEP improved. Robust community, patient, and provider education facilitated the acceptability, implementation, and broad geographic reach of the Program across Cherokee Nation.

Conclusion:
Relationship building and trust supported implementation of a multifaceted EHE Program resulting in increased rates of HIV testing and PrEP uptake among adults. Opportunities remain to continue improving screening among adolescents and to increase the overall utilization of PrEP.