Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health



First Committee Member

Dr. Veenu Minhas, MPH, PhD

Second Committee Member

Dr. Lynette Smith, PhD

Third Committee Member

Dr. Leah Casanave, MPH, DrPH


Background: Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) is a public health strategy to limit HIV infection among at-risk populations. Local health departments (LHDs) promote PrEP initiation by referring patients to private and academic specialty care centers. However, low follow-up compliance remains a challenge in this setting. Between January 2016 and September 2018, Douglas County Health Department, a LHD in Omaha, Nebraska, externally referred 126 clients for PrEP at an academic specialty care center, and only 20 (15%) clients completed a PrEP initiation follow-up appointment. The purpose of this study is to describe the characteristics of clients referred by Douglas County STD Clinic to an academic specialty care center for HIV PrEP services and to identify factors associated with follow-up compliance within this group.

Study objective and goals: The goal of this study is to characterize the client population at Douglas County STD clinic that is externally referred for HIV pre-exposure prophylaxis at UNMC. The primary study objective is to describe demographic and behavioral characteristics of clients who were referred to University of Nebraska Medical Center (UNMC) Specialty Care Center by Douglas County STD Clinic for HIV PrEP between January 2016 and September 2018.The second study objective is to identify factors that are associated with PrEP follow-up compliance among clients referred to UNMC Specialty Care Center by Douglas County STD Clinic within this study group.

Methods: This was a cross-sectional study of clients referred to UNMC Specialty Care for HIV PrEP between January 2016 and September 2018 by Douglas County STD Clinic (n=126). Surveillance records were retrospectively queried and analyzed for this study. The primary outcome was successful follow-up compliance to PrEP initiation visit at UNMC. Continuous variables were recoded as categorical variables and between-group comparisons were made using Fisher’s exact tests. Estimated odds ratios for PrEP follow-up were evaluated using univariate logistic regression models with 95% confidence intervals (CI) and p < 0.05 was considered significant.

Results: A total of n=126 surveillance records were analyzed. Demographic characteristics were similar between individuals who were follow-up compliant (n=20) versus those who were not. In both groups, most individuals were male (100% compliant group versus 89% noncompliant group, p=0.21) with a median age of 28 years (p=0.75) and who identified as white (65% compliant versus 60% noncompliant, p=0.3). Frequencies of social and sexual behavioral characteristics were similar between both groups. History of confirmed positive STI test(s) was significantly associated with PrEP initiation follow-up compliance (p=0.03), and history of a sexual partner’s positive STI screening was associated with PrEP initiation follow-up (p=0.02). Race- and age-adjusted odds ratios (aOR) for follow-up compliant individuals with a sexual partner who had a history of confirmed STI(s) was 4.08 (95% CI: 1.42-11.76), and for those with a personal history of STI infection was 3.72 (95% CI: 1.30-10.64).

Impact: The intended public health impact of this study is to reduce the number of new HIV infections among at-risk populations by improving HIV PrEP uptake and access in Douglas County, Nebraska.

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