- Need: To prevent new cases of HIV in rural Iowa.
- Intervention: TelePrEP provides preventive care via telehealth and prescription delivery.
- Results: Between February 2017 and August 2020, TelePrEP received 456 referrals, with 403 patients completing an initial visit.
Evidence-levelPromising (About evidence-level criteria)
In 2016, 136 Iowans were newly diagnosed with HIV, the largest number reported in the state since 1998, likely due to higher levels of testing. The rural county of Buena Vista had the sixth highest prevalence in Iowa of people living with HIV, with 112 per 100,000 people.
The risk of contracting HIV can be greatly reduced through Pre-Exposure Prophylaxis (PrEP), but the medication must be taken every day and patients need follow-up appointments every 3 months. In addition, rural residents often don't have access to it due to stigma, distance from the nearest specialist, and a shortage of primary care providers willing to prescribe and monitor PrEP.
TelePrEP is a public health-partnered, virtual pharmacist model for PrEP delivery in rural and urban Iowa. TelePrEP partners include the Iowa Department of Public Health and University of Iowa Health Care. TelePrEP is funded by the Iowa Department of Public Health through a CDC Demonstration Project award.
Project coordinators reach out to vulnerable populations, including people with sexually transmitted infections, sexual partners of people living with HIV, and people who inject drugs.
Patients at high risk of contracting HIV can receive video consultations in their own homes. TelePrEP uses a HIPAA-compliant platform that works with smartphones, tablets, or computers and can function in low-bandwidth areas.
Patients complete lab work at an outpatient or public health location and receive their medication at their local pharmacy or through the mail. In addition, patients can communicate with their pharmacist providers outside of visits through phone, email, or texting.
Thanks to a Collaborative Practice Agreement (legal agreement that expands the pharmacist's scope of practice) with the medical director, University of Iowa Health Care pharmacist providers can order labs and prescribe and adjust medications based on lab results and patient history/assessment.
For more information about this program, please watch this video:
TelePrEP has served more than 400 patients, of whom more than 90% have started PrEP medication. TelePrEP services are available throughout the state of Iowa. The Health Resources & Services Administration (HRSA) listed the project as a Health Center Promising Practice.
Between February 2017 and October 2018, there were 127 initial video visits with pharmacists and 186 referrals. For more information:
Hoth, A.B., Shafer, C., Dillon, D.B., Mayer, R., Walton, G., & Ohl, M.E. (2019). Iowa TelePrEP: A Public-Health-Partnered Telehealth Model for Human Immunodeficiency Virus Preexposure Prophylaxis Delivery in a Rural State. Sexually Transmitted Diseases, 46(8), 507-512. Article Abstract
Since initiation of TelePrEP in 2017, project coordinators experienced the following challenges:
- Raising awareness of PrEP – especially in rural counties and among people of color
- Addressing patients' privacy concerns
- Addressing stigma
- Complexity of navigating insurance coverage for lab test and medication
Patients with high deductible healthcare plans and uninsured patients face challenges with some of the lab or out-of-pocket costs.
Create relationships with people and systems already in place and build on successful work.
Understand the community you are trying to reach. Asking patients about their needs and perceived barriers to care keeps patients invested in your project and helps you shape it to best fit their needs.
Be flexible and create a service that can change rapidly when something doesn't work and strengthen the aspects that are working.
HIV and AIDS
August 27, 2018
Date updated or reviewed
September 16, 2020
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.