Bringing Iowa TelePrEP to Scale: A Qualitative Evaluation.

Regional partnerships between public health organizations and telehealth programs have the potential to expand access to HIV pre-exposure prophylaxis in rural and small urban areas. However, little is known about the best practices for such partnerships. Iowa TelePrEP, a regional public health‒partnered telehealth model created by the Iowa Department of Public Health and the University of Iowa, expanded statewide between 2017 and 2019. This qualitative evaluation assessed the barriers and facilitators to statewide expansion and the lessons learned. Key informants from public health partners across Iowa participated in a focus group and interviews between May 2019 and November 2020. Public health partners included local health departments and disease intervention specialist/partner services programs. Qualitative data were transcribed and thematically coded. Program documents and routinely collected reporting data were reviewed to provide the context for qualitative findings. Data were analyzed in 2020. TelePrEP expanded in 4 phases through partnerships with 12 public health partners. Public health partners referred 708 clients with pre-exposure prophylaxis indications to telenavigation; of these, 258 were navigated to TelePrEP, and 167 initiated pre-exposure prophylaxis. The facilitators of expansion included early public health partner engagement, model acceptability and inclusion of a navigator, and adaptability to local public health partner settings. The barriers included the need to adapt communication and processes to varying public health partners, difficulty in engaging underserved populations, the COVID-19 pandemic, and perceived gaps in understanding client outcomes. Partnerships between regional telehealth programs and local health departments can expand to the state level and increase the capacity to implement pre-exposure prophylaxis in rural and small urban settings. Partnerships should consider how to balance program adaptability to local public health partners with standardization and scalability.

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