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The stigma surrounding sexually transmitted infections like Human Immunodeficiency Virus (HIV) often leads to misinformation and discomfort in discussing sexual health. However, since the mid-2000s, community health centers have been at the forefront of combating this stigma. They have ramped up services and programs aimed at increasing access to HIV and STI prevention and treatment. Their efforts in expanding education, reducing stigma, and improving access to health care steward population health. Community health centers, being well-situated to educate patients about sexual health, play a vital role in engaging Oregonians in harm reduction.

Today, the HIV/STI Program at Oregon Primary Care Association is highlighting how Oregon health care providers are maximizing efforts to fully realize the benefits of a preventive medication called HIV Pre-exposure Prophylaxis (PrEP). You’ll learn:

  • What is HIV PrEP?

  • Updates on the PrEP@Home study conducted by a clinical faculty member from OPCA’s HIV/STI Program.

  • Resources to support PrEP prescribing at CHCs, including one-on-one mentoring, education, and technical assistance.

Resources, tools, and upcoming learning opportunities mentioned in this blog are available in the CHC Toolbox section.

Pre-Exposure Prophylaxis (PrEP)

HIV Pre-exposure Prophylaxis (PrEP) is a safe, well-tolerated, and highly effective medication. HIV PrEP significantly reduces an individual’s risk of acquiring HIV. The U.S. Food and Drug Administration approved the first medication for HIV PrEP in 2012. Since that time, several oral and injectable options have entered the market, including lenacapavir, which received approval in June 2025 as the first PrEP option administered as a twice-yearly injection.

When taken as prescribed, PrEP is about 99% effective in preventing sexual transmission of HIV and at least 74% effective in preventing transmission through injection drug use. Given these high efficacy rates—higher than most vaccines—widespread use of HIV PrEP among individuals at increased risk has the potential to reduce or even eliminate new HIV infections. Accordingly, the CDC recommends that all sexually active individuals and people who inject drugs receive education about PrEP. The CDC also recommends providers to provide a prescription to anyone who requests it.

However, despite its proven effectiveness, access to PrEP remains limited for many who could benefit from it. Some of the most common barriers include lack of awareness, lack of health coverage and/or insurance, and limited access in rural or underserved areas. As a result, these challenges disproportionately affect communities that are most at risk.

Therefore, reducing barriers to PrEP access is crucial. Not only does PrEP increase opportunities for early detection of HIV through routine testing, but it also encourages individuals to co-manage their health alongside their care team. The importance of early detection cannot be overstated. It allows for timely intervention and more effective management.

To explore this further and gain insight into local efforts of increasing access to HIV PrEP, OPCA interviewed one of the HIV/STI Program’s clinical faculty members.

Interview

I had the opportunity to interview Chris Fox, a clinical faculty member from OPCA’s HIV/STI Program to learn about the PrEP@Home study he is conducting. To begin our conversation, I asked Chris to share a little about himself.

Assistant Professor of Medicine,
Division of General Internal Medicine
and Geriatrics, School of Medicine
Oregon Health & Science University

“My primary practice is in the HIV clinic at OHSU, where I do HIV primary care and HIV specialty consultations for people around the state. I’m also the clinical lead for OHSU TelePrEP Program, which offers PrEP telemedicine services to individuals throughout the state. Then I am a clinician with the PATHS (Peer Assisted Treatment of Hepatitis C and Syphilis) program. We provide telemedicine Hepatitis C treatment around the state, primarily in rural counties, with the assistance of peers who have lived experience in substance use or Hepatitis C.”

“Much of the HIV health care workforce were first responders to the epidemic. These doctors, nurses, and other folks started their HIV careers in the early 80s or the 90s, when the epidemic was at its worst. And because the epidemic has lasted so long, many of those individuals have reached retirement age. So, there’s a need, you know, there are still people living with HIV. It takes a specific skill set to care for someone with HIV. It takes a particular sort of attitude and knowledge about the experience of people living with HIV. My interest in education is around workforce development and making sure that, as the first generation of providers ages out into retirement, there are new providers to take over the care of people living with HIV. And so when I arrived at OHSU, I just met up with Dayna, Sr. Director of OPCA’s HIV/STI Program, and started talking about my interests. Which are partly patient care and partly training new and current healthcare providers around HIV and STIs, which is very similar to [OPCA’s HIV/STI Program] around developing education.”

Christopher B. Fox, M.S.N., RN, ANP-BC, AAHIVS, Oregon Health & Science University

Response from: Christopher B. Fox, M.S.N., RN, ANP-BC, AAHIVS, Oregon Health & Science University

Challenge #1: “[When] we designed the study, we wanted to enroll enough people in rural areas that we would be able to do some comparison between people in the Portland metro area and other cities in Oregon versus people in rural areas. There’s a huge unmet PrEP need in rural areas. Without a program like ours, it would be nearly impossible for many people in rural areas to access injectable PrEP. Unfortunately, we have only had one or two people in rural areas enroll, and everyone else is in the Portland metro area. Our hope was that we would be demonstrating that this would be a good model for bringing PrEP to rural areas, but so far, it hasn’t worked out that way. The FDA [recently] authorized long-acting lenacapavir, an every six-month PrEP injectable. We hope to provide that to folks, which might be more attractive since there are less frequent injections. So, we’ll have to see what happens in the future.”

Christopher B. Fox, M.S.N., RN, ANP-BC, AAHIVS, Oregon Health & Science University

Challenge #2: “Although, we had many people very interested in long-acting cabotegravir, there were significant barriers to moving from interest to actually getting an injection. Of the participants referred to the home infusion pharmacy for this PrEP option, only about 50% were able to receive an injection. This is consistent with the very limited data about long-acting PrEP at other locations around the country. One of the reasons why people weren’t able to get that injection included insurance, of course. You know, insurance barriers are always an issue. But some people were just lost to follow up, which says something about other barriers. There’s something inherent in PrEP access that’s challenging, and I think that applies to oral PrEP as well. You know, a large proportion of people who start oral PrEP don’t persist on it. They might pick up a bottle and use it for three months, and then stop using it. So, it’s really this idea of persistence and adherence to PrEP that’s still a challenge, I think, for all of us who offer PrEP. We can create PrEP options that are more and more effective and convenient, but there’s still work we need to do around [encouraging] people who start PrEP to remain on PrEP with support from their care provider.”

Christopher B. Fox, M.S.N., RN, ANP-BC, AAHIVS, Oregon Health & Science University

Response from: Christopher B. Fox, M.S.N., RN, ANP-BC, AAHIVS, Oregon Health & Sciences University

Provider Mentoring, Education, and TA

The HIV/STI Program at OPCA offers one-on-one mentoring to Oregon providers on a variety of topics, including HIV PrEP. Their dedicated team of clinical faculty works directly with providers to distill the latest evidence, share tools, answer questions, and offer expertise. Check-ins are brief, offered at no cost, and content is always free of commercial bias.

Health center providers can schedule mentoring with clinical faculty, including Chris Fox, by visiting oraetc.org/prescriber-support.

The HIV/STI Program at OPCA also offers online and in-person clinical trainings to health centers across Oregon. They can work with your team to tailor an event that aligns with your clinic’s training priorities and schedule. Commonly requested training topics include:

  • HIV PrEP and PEP prescribing and management
  • HIV screening, delivering a positive test result, and linkage to care
  • STI Update
  • Syphilis Update
  • HIV treatment rapid starts in primary care

Health centers can contact Ashley Allison, HIV/STI Prevention Director at OPCA, with any training requests at aallison@orpca.org.

CHC Toolbox

This opportunity is available to physicians, advanced practitioners, nurses, and pharmacists practicing in the state of Oregon. Clinical faculty experienced in:

  • STI Screening & Treatment
  • Syphilis & Congenital Syphilis
  • HIV Clinical Prevention (PrEP & PEP)
  • HIV Diagnosis & ART Initiation

Oregon AETC | Connect with Oregon AETC Clinical Faculty to Take Action

The PrEP Provider List is a moderated list of providers in Oregon and SW Washington that prescribe Pre-Exposure Prophylaxis (PrEP) to prevent HIV. If there is a provider that prescribes PrEP that is not listed in the directory below, please feel free to submit a listing using the +Add Entry button. All submissions will be reviewed by a moderator and added to the list accordingly. If you see any inaccurate listings below, please let us know by sending an email to info@oraetc.org.

Oregon AETC | PrEP Provider List

Short description

OHA | PrEP Guide for Providers and Navigators

This free resource was developed at the University of Washington for health care professionals who want to learn about HIV PrEP.

Funded by:

  • Centers for Disease Control and Prevention (CDC)
  • Health Resources and Service Administration (HRSA)

National HIV PrEP Curriculum

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NASTAD | PrEP Billing Code Guide for HIV Prevention

There is a subpage under the HIV Basics section on the HIV.gov website that provides information in a Q&A format to help patients understand, what is PrEP? This may be helpful to providers in starting a conversation with patients at high risk of exposure to HIV.

HIV.gov | Pre-Exposure Prophylaxis

This resource is from the CDC HIV page about Preventing HIV with PrEP. On the page is a short 1-minute video designed to explain PrEP to patients. This may be a great supplemental material to literature you provide to a patient.

CDC | Preventing HIV with PrEP

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OHSU | Tele-PrEP Program

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OHSU | Home Infusion Pharmacy Services

On June 27, 2025, the United States Supreme Court issued its decision on Kennedy v. Braidwood, addressing the constitutionality of the U.S. Preventive Services Task Force (USPSTF) and its preventive service recommendations under the Affordable Care Act (ACA).

NASTAD | Press Release

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