Testing Center Director Omi Singh explains telehealth at the 2023 U.S. Conference on HIV & AIDS.

Telehealth Options Expand HIV Testing, PrEP Uptake

In important milestones, HIV testing at GMHC now exceeds pre-pandemic levels. Our Testing Center counselors have also significantly increased the number of clients they’re able to connect with PrEP (pre-exposure prophylaxis) services for HIV prevention.

These increases are thanks to the agency’s adoption of telehealth options for HIV self-tests and its partnership with telehealth provider Q Care Plus and Avita Pharmacy to expand PrEP access.

HIV and STI testing dropped sharply during the pandemic, both in New York City and nationally, due to decreases in social interaction and sexual activity from shelter-in-place orders for COVID-19.

“Folks were literally not getting tested,” said GMHC Testing Center Director Omi Singh. “We’ve seen many people in the past year or two saying it was the first time they were receiving HIV testing since COVID-19 – and some folks have reported that they stopped taking PrEP during the pandemic because they were not having sex.”

During the pandemic, GMHC quickly pivoted to telehealth as another HIV testing option. Testing Center staff started providing clients with at-home HIV test kits from the NYC Department of Health and Mental Hygiene, with follow-up education and counseling by phone. “Self-tests are empowering for people in taking control of their sexual health,” Singh said. “It’s a paradigm shift for us as providers.”

Singh said client demand for HIV self-tests was highest in 2020, but that there is continued interest. “We’ve seen a high number of first-time HIV testers requesting the self-tests, and many women also ask for them, rather than come into our office,” she said. “We are reaching new types of people.”

“HIV testing can still be scary and possibly stigmatizing for folks,” she explained. “People might not feel comfortable talking about their sexuality and sexual practices, so they feel safe and private taking an HIV test at home. We’re still here for support when needed.”

This year, GMHC’s HIV testing has rebounded. Testing Center counselors have administered about 20% more HIV tests per month on average than before the pandemic. From January through August, they performed about 1,750 HIV tests–almost 1,500 in person and 250 through at-home self-tests with follow-up counseling. That averaged 219 HIV tests per month, compared with an average of 184 HIV tests per month for the first quarter of 2020, before the pandemic.

To expand access, GMHC is providing a walk-in HIV testing option on Thursdays until 6 p.m., in addition to testing by appointment every weekday. The Testing Center staff continue to do community outreach for testing at St. John’s Lutheran Church on Christopher Street.

They also deploy a mobile testing unit to New York City’s five boroughs. “It gives us the flexibility to take HIV testing to a lot of communities that need these services,” Singh said. “The mobile testing unit has gone to churches that have health fairs, back-to-school events at colleges and universities, bars and clubs, and even high-volume corners by subway entrances.”

Increasing PrEP Access

The pandemic has made people more comfortable with telehealth services in general, Singh said, because of their experience with COVID-19 self-tests and telehealth consultations.

Offering telePrEP has markedly increased PrEP uptake for the agency’s clients. PrEP is a critical tool for reducing HIV transmission because the medication is 99% effective in preventing HIV when taken daily. However, it requires a medical prescription and regular HIV/STI testing every three months for refills.

For PrEP services, GMHC’s Testing Center refers many people who come in for HIV testing to its network of medical providers across New York City. But Singh said there had been a roughly 50% attrition rate for clients referred to in-person health care providers, because they often missed appointments or didn’t follow up.

“What we saw was that some didn’t complete the process to make a provider appointment and get a prescription,” Singh said. Clients reported barriers, such as long wait times to see clinicians for prescriptions, difficulty navigating insurance requirements, and prohibitive out-of-pocket costs.

The Testing Center found a solution by partnering with Q Care Plus and Avita Pharmacy in May 2022. Q Care Plus, founded in 2020 to focus on telePrEP services, and Avita are both staffed by culturally competent providers to provide clients with stigma-free care.

The partnership expands GMHC’s one-stop service model, Singh said, to make it easier for clients to obtain care. When clients come in for HIV testing, or take an HIV self-test, they can quickly obtain a PrEP prescription from a Q Care clinician via a telehealth visit, then fill it at the Avita Pharmacy that opened on-site at GMHC last year. Avita can also deliver it by mail.

“We wanted to make it as easy as possible for people to receive PrEP with minimal intermediate steps,” Singh said. “We were also trying to bridge a gap for people who were struggling to find a provider for PrEP.”

By adding the telePrEP option with Q Care Plus, the Testing Center has increased by almost fivefold the number of clients accessing PrEP. From May 2022 through August of this year, 1,267 clients have completed at least one telePrEP appointment through Q Care Plus, compared with 266 clients referred to in-person providers. Q Care clinicians have prescribed PrEP to 90.6% of these clients (1,148 clients).

“We have many clients getting HIV testing and PrEP through Q Care who weren’t before,” Singh said. “It’s expanded our client base,” she added, by allowing GMHC to reach people in a much wider geographic area.

Making PrEP Affordable

For PrEP, GMHC covers the cost of HIV/STI testing and lab work, as well as fees for Q Care clinicians. The cost of the HIV-prevention medication itself is covered by insurance. Singh said most insurers are complying with U.S. Preventive Services Task Force requirements to cover all PrEP costs. The state also offers a PrEP assistance program for low-income people who are uninsured, as does the pharmaceutical manufacturer.

For uninsured clients wanting to take PrEP, GMHC’s health care navigation team can help them obtain health insurance through an Affordable Care Act plan, Medicare, or Medicaid.

“I love the idea of giving people additional options to take care of themselves,” Omi said. “We want to empower people to take care of their health and their sexuality, so we’re making sure they have the structures and options to do that.”


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