The Two-Door Approach: Enhancing PrEP Uptake with the HIV/PrEP Toolkit

Abstract

In 2022, over 38,000 new HIV infections were diagnosed in the United States disproportionately affecting non-dominant racial and ethnic populations and Southern United States. While pre-exposure prophylaxis (PrEP) is 99% effective, uptake of this regimen remains low, mainly owing to structural barriers, stigma, and perceived and actual discomfort among providers. This problem presents the PrEP/HIV Toolkit (see www.grlgbtqhealthcareconsortium.org/toolkit) as a novel, equity-focused solution for scaling up HIV prevention. The toolkit was designed with a “two-door” approach, with each “door” tailored to health care providers and community members information needs, facilitating a two-way exchange of information, and empowerment. By integrating evidence-based resource decision-support tools, and stigma-reducing messaging, the toolkit achieves its goal to dismantle barriers to PrEP access. It also leverages QR code-sharing functionality to optimize accessibility and fill information gaps between parties. Since its launch on September 28, 2024, the toolkit has demonstrated international reach, with users in 97 countries and all 50 U.S. states represented. Future directions include refining accessibility features, intensifying partnerships with health care payers and policymakers, and integrating best-practice alerts for use in any electronic health record software. This toolkit is an actionable, scalable solution to improve PrEP uptake and reduce new HIV infections by promoting informed, stigma-free discussions in both clinical and community environments.

Keywords

HIV/AIDS sexual health access to care infectious disease/control/prevention LGBTQ +minority health sexual and gender minorities community health primary care engagement global health

Assessment of Need

The United States saw the detection of over 38,000 new HIV cases in 2022, highlighting the need for better prevention (Centers for Disease Control and Prevention [CDC], 2024). Pre-exposure prophylaxis (PrEP) is a preventive medical strategy for people who do not have HIV. These individuals are prescribed an antiretroviral medication (oral or via injection) to reduce their risk of contracting HIV (CDC, 2024). Despite PrEP’s 99% effectiveness per the CDC (2024), Chan et al. (2020) found only 10% of those who could benefit are using it. Research shows this is due to structural injustices including systemic barriers disproportionately affecting access to PrEP (Sullivan et al., 2024)., stigma (Pitasi et al., 2021), health care practitioners’ discomfort discussing sexual health and low provider knowledge (Agovi et al., 2020). The purpose of the PrEP/HIV Toolkit (see www.grlgbtqhealthcareconsortium.org/toolkit) aims to reduce stigma, improve accessibility, and promote HIV prevention strategies via information sharing to impact behaviors.

Description of Strategy/Innovation for the PrEP/HIV Toolkit

The goal of the PrEP/HIV Toolkit (see www.grlgbtqhealthcareconsortium.org/toolkit) was to understand and address barriers to HIV preventive behavior within communities and care settings. When reviewing current barriers to uptake of PrEP, several themes emerged, including specific limits on both the community member and clinician side. Current barriers to HIV risk reduction and need were determined by leveraging literature searches including PubMed, CINAHL, and Google Scholar searches. These searches were limited to those being less than 5 years, held in the United States, peer reviewed and published in English. Current evidence-based practices were also leveraged from sources such as HIV.gov, the CDC as well as the National Institute of Health (NIH). The themes from this assessment and literature review became components of the toolkit and aided in the organization of information delivery. The PrEP/HIV Toolkit (see www.grlgbtqhealthcareconsortium.org/toolkit) project strategy has centered around addressing research-identified contributors to the lack of HIV preventive care, with action steps for the community member and health care team.

The health care team and community member populations have different information, and workflow needs to address HIV prevention. The PrEP/HIV Toolkit (see www.grlgbtqhealthcareconsortium.org/toolkit ) leverages a “two-door” approach to meet these differing needs, while also providing an avenue for information exchange between community members and the health care team. Strategies and innovations also included the ability for each party to share a QR code to the “opposite side” of the toolkit. This was done to address imbalances in power between community and health care team members, and promote learning. Specific talking points to empower conversations and destigmatize discussions related to behavior associated with HIV risks have been included.

The contributors to the project were a critical part of the content strategy and composition. These individuals possess unique lenses within the health care ecosystem. Contributors and peer reviewers included representatives from public health, a triple-boarded internal medicine doctor (infectious disease, and addiction medicine), pharmacist, nurse practitioners, communication experts, and more. Community members with experience related to PrEP and HIV risk were also leveraged to highlight information needs and ease of navigation of final toolkit components.

Intended Impact & Evaluation

Knowledge gaps about available preventive medications, their effectiveness, and associated costs, along with persistent stigma rooted in racism, homophobia, and misinformation (Pitasi et al., 2021) have hindered the integration of PrEP into health care settings. This project aims to improve HIV prevention care by increasing awareness and understanding among all members of the health care team, including community members. The intended outcomes include increased use of a standardized risk assessment flowchart to guide PrEP prescribing decisions, improved knowledge of financial assistance programs and proper billing documentation to reduce the cost of PrEP and related services, and greater awareness of harm reduction resources such as local needle exchange programs. The broader impact of the project is to reduce new HIV infections and combat misinformation and stigma surrounding HIV prevention. By providing clear, actionable information and promoting access to evidence-based tools and services, this toolkit supports informed decision-making and encourages proactive prevention efforts among care team and community members.

Evaluation Approach

This project’s initiation and implementation demonstrates success with worldwide engagement with the toolkit’s components. An evaluation of website clicks, location demographics of visitors, as well as time spent within various toolkit components is being leveraged to assess and quantify the impact of information engagement. During the toolkit’s first year, 42 individual countries were represented among visitors, including top visitors from outside the United States being Canada, United Kingdom, Russia, and Australia. Within the United States, 100% of states were represented, with top visitors being from Michigan, California, Illinois, Virginia, New York, and Ohio. The total number of visitors as of September 28, 2025 (24 months postlaunch) is 1,491 with 97 countries represented. From June to December 31 of 2024 (329 clicks) compared to the first 6 months of 2025 (353 clicks) demonstrate a 7.3% increase in engagement.

Challenges and Successes

Challenges in navigating sources of information related to HIV prevention and nuances of health care delivery were inspirations in the design and layout of content within the PrEP/HIV Toolkit (see www.grlgbtqhealthcareconsortium.org/toolkit ). A barrier to reliable information was furthered in January 2025, because information accessibility provided by the NIH and the CDC was disrupted. This interruption in access to research and evidence resulted in the creation of an archive dedicated to the preservation of access to these documents attached to the toolkit. Efforts were also made to preserve other sexual health and LGBTQ+ research to ensure access is maintained. This shift in information availability also provided an opportunity to further improve links to evidence-based guidelines and cultivate a space hosting both HIV prevention guidelines and tools for those living with HIV, which had previously not been included. With this shift in information access, the PrEP/HIV Toolkit (see www.grlgbtqhealthcareconsortium.org/toolkit) saw a 225% increase in engagement during the first week of information loss.

Next Steps

To advance this intervention, several key initiatives are planned. Including a comprehensive awareness campaign will be launched, utilizing social media platforms, press releases, and active engagement in HIV and LGBTQ+ community events. This campaign is designed to enhance public knowledge and visibility of HIV prevention strategies found within the toolkit. The integration of additional languages and culturally tailored content to better serve diverse populations is planned. Accessibility features for individuals with visual impairments will also be evaluated and incorporated to ensure equitable access to information.

In addition, strategic partnerships will be pursued with health care payers and policymakers. These collaborations aim to improve the dissemination of accurate and comprehensive information regarding financial assistance programs and insurance coverage to keep toolkit content current. Finally, the toolkit will be expanded to include additional prevention strategies and clinical decision support tools. This includes the development of educational materials promoting the use of doxycycline for postexposure prophylaxis and the implementation of a best practice alert system logic model for use within electronic health records. This alert system is intended to support clinicians in identifying patients at elevated risk for HIV and guiding appropriate preventive care.

Implications for Practice

The PrEP/HIV Toolkit offers a multifaceted approach to dismantling stigma and structural barriers that hinder HIV prevention efforts. Central to its design is the intentional use of affirming, equity-focused communication strategies and transparency to support both health care teams and community members in engaging with PrEP confidently and compassionately.

Breaking Down Stigma and Bias

To foster stigma-free environments, the toolkit includes tailored scripts for both providers and community members. Provider scripts are crafted to encourage informative, evidence supported, nonjudgmental conversations about PrEP. These acts help clinicians navigate sensitive topics with clarity and empathy and address research shown barriers. Simultaneously, community scripts empower individuals to ask essential questions, engage in self-advocacy, and normalize PrEP access within their health visits. These resources are reinforced by affirming guidelines that promote unbiased, supportive care for all individuals, regardless of background, identity, or perceived risk.

Breaking the Barriers of Self-Censorship

The toolkit also addresses self-censorship in clinical and community settings in several ways, including normalizing conversations around PrEP. This acts to encourage both the health care team and community members to initiate discussions. This proactive stance is vital in overcoming silence rooted in stigma, misinformation and/or disinformation. In addition, the toolkit challenges assumptions about cost by introducing accessible resources in one place to offset financial barriers, making PrEP a viable option for more individuals. To further streamline access, it supports primary care teams in prescribing and managing PrEP directly, reducing reliance on specialist referrals that often delay, and can disrupt limited resource allocation.

Together, these practice-oriented components of the PrEP/HIV Toolkit contribute to a more inclusive, informed, and empowered approach to HIV prevention. They align with the toolkit’s overarching goal: to promote stigma-free, evidence-based conversations that advance health equity and reduce new HIV infections.

Implications for Policy and Research

This toolkit was developed using reliable, evidence-based sources to create centralized information hubs that support clinical decision-making and patient education. By embedding citations and direct links throughout, the toolkit ensures transparency and sustained access to current guidelines—even with recent data removals/alterations from federal agencies such as the CDC and NIH. In practice, the toolkit equips health care providers with actionable resources to counter misinformation, guide PrEP prescribing through standardized risk assessments, and connect patients to culturally competent, financially accessible prevention information. These tools are designed to be integrated into routine care workflows, enhancing health care team and community member confidence and consistency in HIV prevention delivery. From a research and policy perspective, the toolkit illustrates how evidence-informed resources can mitigate the negative effects of misinformation, address stagnant PrEP uptake, and reduce racial and gender disparities in HIV prevention. It also highlights the need for sustained policy support to maintain open access to public health data and to fund inclusive, community-informed prevention strategies.

Footnotes

ORCID iDs

Jay J. Knight

Elena Lafata

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