Expanding Access to STI & PrEP Services through Nurse-Run Sexual Health Clinics

In a health system where it can be challenging to see patients quickly due to provider capacity and the availability of culturally competent care, providers often struggle to find appointment slots to address all of a patient’s concerns in one visit.

Patients face barriers due to cost, access to care, medication, and the stigma that can be attached to sexual health treatment, particularly for marginalized communities.

The goal of Wallace Community Health’s Nurse-Led Sexual Health Clinic is to increase access to care for Latinx/e, gender expansive, and sexual minority patients.

The clinic has expanded beyond same-day PrEP initiation for Latinx/e patients to include comprehensive screening/treatment, DoxyPEP, and gender inclusive care for a primarily Spanish speaking patient population enabling nurses to work at the top of their license.

OPCA’s Health Equity has the pleasure to interview Ari Rapkin, RN, BSN at Wallace to learn more about their clinic and the services they offer.

Tell us about Wallace Community Health’s Nurse-Led Sexual Health Clinic. What specific responsibilities and tasks are handled by the nurses?

Through the use of standing orders, RNs can offer STI testing, treatment, prevention and education services to our patients and community members. This includes offering PrEP, PEP and doxyPEP.

How long has the nurse-led sexual health clinic been operational at Wallace and what inspired it?

The clinic began operation in July of 2023. It was inspired in part by the relative lack of timely sexual health services in the community Wallace is located in. People were waiting weeks for appointments with their primary care providers and we recognized that many sexual health concerns are time sensitive and could be addressed more quickly and efficiently. At the same time, I have a personal interest in destigmatizing sexual health and wanted to ensure that we are offering affirming care to our entire community.

What in your life led you to this work in Wallace?

Before I became a nurse and started working at Wallace, I encountered a number of barriers to accessing affordable, sex-positive and gender affirming health care as a queer, trans, working artist (translation: underinsured person). I had to do a lot of education and advocacy to get the care that I needed.

I recognized that if I encountered so many challenges with a relatively high degree of privilege and health literacy, most of our patients could face even more barriers. I realized that I was in a unique position to help facilitate more timely and appropriate care.

How are nurses encouraged to work at the top of their license and how has it contributed to the overall effectiveness and efficiency of the clinic?

Nurses are able to use standing orders, standardized procedures and clinical nursing judgement to give highly efficient report to providers and minimize provider demand for time. We are able to balance competing demands by using our time efficiently to complete other tasks while sexual health clinic slots might be open.

How does the clinic’s approach to same-day PrEP initiation for Latinx/e patients improve access to care?

Patients are able to walk in to their appointments and have their questions answered, run labs, and walk out with a PrEP prescription in the same visit. Same day appointments are available 3 days a week and walk-ins are accepted as capacity allows.

With a primarily Spanish-speaking patient population, what practices have you implemented and prioritized to overcome language barriers?

The majority of [Wallace’s] nurses are bilingual. Visits can happen in Spanish or English without needing an interpreter, and printed educational materials are readily available in Spanish or English.

Can you share any success stories or notable impacts the clinic has had on its patients?

One of my favorite parts of the visits is being able to offer education about PrEP and how effective it is. It’s not the right tool for everyone, but there are a lot of people who don’t know it’s an option. Some folks have started PrEP the same day they learned about it, and a lot more have been excited to tell their friends and family about it as an option. I believe that the impact of the clinic reaches farther than just the individuals we see in clinic.

What strategies do you use to engage and educate the community about the services offered at your clinic?

We have worked with community partners to make sure that information is widely available about the clinic. We have digital and physical flyers about the clinic.

How do you ensure that these strategies are culturally relevant and effective?

Our information is available in Spanish and English and we have reached out to organizations in the community that center the Latine/x community.

In what ways has the expansion of services beyond PrEP initiation improved the overall health and well-being of your patient population?

It is rare that a patient comes in only seeking a prescription for PrEP. Most often, patients seek STI testing or treatment without realizing that PrEP might be right for them. When patients receive affirming, empathetic care without judgement, they are able to get their concerns addressed more appropriately and have access to better health overall.

What challenges have you encountered in your efforts to increase access to care for these underserved populations?

I see the biggest challenge is access to time and resources. The clinic has a limited number of visits per week and along with other nursing responsibilities it is usually difficult to find time to engage the broader community to ensure that our services are known. In addition to outreach, plans for possible expansion and evaluation compete with demands for time spent in other areas.

Looking ahead, what are your plans for enhancing health equity through the Nurse-Run Sexual Health Clinic and expanding to other populations?

We are currently examining ways the nurse team can support providers in providing gender affirming care. We have also explored ways to expand access to contraception. There is also the possibility to coordinate services more with our organization’s school based health programs.

How do you reach the minority populations this clinic aims to serve in areas that have previously avoided medical care due to stigma?

I’m thrilled that changes to Oregon state law have enabled more people to access state-sponsored health insurance and have found that to substantially lower barriers to care. In addition, over the last two years we have been conducting an internal review and working to improve policies to increase health equity for LGBTQ+ populations. We are positioning ourselves to be leaders in health equity for sexual and gender minority populations while continuing to focus on providing excellent care to our patient population which is predominantly Latino/e/x.

For clinics interested in implementing a similar program, what advice or lessons can you learn to help them to get started?

We worked closely with our Quality Improvement staff to think through work flows and make sure that adequate support and resources were in place before beginning operation. We made sure there was a workflow and communication plan about available services and that the nurse team had access to clinical information, tools and training, physical space, standing orders that ensured operation within our scope, provider availability for consult, and capacity of the interprofessional care team. While it may require an inspired individual to mobilize change, having motivated co-conspirators makes it much easier and more effective.

What else do you want your statewide colleagues to know about the work being done at Wallace?

Collaboration and communication is great. I’d love to hear from others doing similar work and am happy to answer any questions or compare models for anyone who is interested.

Ari can be contacted via email at arir@mywallace.org for anyone interested in learning more about this program.

Relevant resources for FQHCs:

• Oregon AIDS Education Training Center
National HIV Curriculum

National STD Curriculum

National HIV Prep Curriculum

National Clinician Consulting Center (for HIV related questions)

• National Network of STD Clinical Prevention Training Centers

CDC/DHHR 2021 PrEP Clinical Practice Guidelines

Nurse – led HIV Preexposure Prophylaxis in the United States: Landscape, Opportunities and Challenges, Medical Research Archives

Pre-Exposure Prophylaxis (PrEP) – CDC

For clinical advice: Call the National Clinicians Consultation Center PrEPline at 855- 448-7737 or go to their website

Oregon Nurse Practice Act

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