Implementing a Nurse-led HIV Pre-exposure Prophylaxis Service (PrEP-RN) in a Public Health Unit STI Clinic: A Public Health Reform Analysis
Bibliographic record
Abstract
HIV pre-exposure prophylaxis (PrEP) is an efficacious pharmacologic HIV prevention strategy aimed at persons who are high-risk for HIV infection. Historically, PrEP uptake has been limited by systems-level barriers relating to the high cost of medications and few prescriber access points. In Ottawa, a team of researchers and clinicians sought to increase PrEP access to priority groups by implementing a fully nurse-led PrEP service, known as PrEP-RN, as part of the public health unit's sexual health clinic. This program was the first of its kind in Canada and required consideration from multiple stakeholders within the public health unit, and the Ottawa community. Patients at highest risk for HIV acquisition were offered a referral to PrEP-RN through a provider-driven, active-offer process by public health nurses, and medication coverage was provided to uninsured patients to ensure equal access to PrEP services. Preliminary results showed a 40% uptake of PrEP referrals among high-risk patients, demonstrating that this reform has been effective at reaching some priority groups; however, many persons continue to decline PrEP due to individual perceptions of risk (i.e., feeling they do not need this HIV prevention intervention).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.026 | 0.001 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.005 | 0.002 |
| Bibliometrics | 0.003 | 0.015 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.005 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.004 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".