(P181) CHALLENGES IN PROVIDING TA TO ENHANCE DELIVERY OF STI/HIV SCREENING AND PREVENTION SERVICES AT AN FQHC IN NYC

Background:
In the face of increasing STI rates and low PrEP uptake, primary care settings are well-suited to expand access to these services. CDC-funded New York City STD/HIV Prevention Training Center (PTC) provided technical assistance (TA) to Morrisania Clinic (MC), a federally qualified health center (FQHC) in the Bronx, NYC, to increase delivery of PrEP and implement three-site STI testing.

Methods:
After conducting initial assessments with MC via structured discussions with key clinic personnel, PTC developed a tailored plan, which included trainings, monthly strategic planning meetings, and ongoing clinical guidance, and was updated as clinic needs and capacity evolved.

Results:
Ongoing assessments with clinic leadership revealed that, while leadership is committed to integrating these services, staff resistance affects implementation. Resistance appears rooted in: 1) discomfort in discussing sexual health with patients; 2) disagreement about workflow responsibilities; 3) perceptions that this work was not their clinic’s responsibility. To address these sources of resistance, from fall 2021 through 2023, PTC delivered seven trainings, shared sample protocols and resources, provided feedback on workflows and procedures, worked with MC health system leadership to support implementation and utilization of EMR resources, and conducted a premortem brainstorm activity prior to STI testing workflow implementation. These activities led to 1) more routine offer of PrEP, increasing the number of PrEP prescriptions from 8 in 2021 to 29 in 2023; 2) new workflows for adolescent/young adult three-site STI testing.

Conclusion:
PTC’s experience partnering with an FQHC to support PrEP services and introduce three-site STI testing highlights the importance of staff buy-in at varying levels and the role of clinic champions. Training and ongoing TA are necessary to successfully increase delivery of PrEP and implement three-site STI testing protocols, though progress may be slow. Given the importance of engaging FQHC’s in reducing community burden of STIs and HIV, there is value in persistence.