Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Julio Lujano


In 2012, the Food and Drug Administration approved a combination medication named Truvada (tenofovir/emtricitabine) as a prophylactic treatment to prevent HIV transmission. Truvada is also known as pre-exposure prophylaxis (PREP). PREP is a one-pill-a-day regimen proven to be 99% effective against HIV-1 transmission from sex and intravenous drug injection when taken daily. The uptake of PREP remains low because primary care providers fail to identify patients who meet the requirements to start PREP and fail to prescribe PREP for patients at risk. The purpose of this quality improvement project was to increase the uptake of PREP in patients at risk of HIV acquisition. The overall objective was to implement the U.S. Preventive Services Task Force screening guidelines for HIV acquisition risk and implement the guidelines recommended by the CDC for PREP in primary care.The providers were asked to screen all patients aged 19 to 65 years for risk of HIV acquisition during a well visit, prescribe PREP upon patients’ consent, and monitor the patients on PREP according to the standard of care. The outcomes were evaluated by retrospective chart review to ensure that 85% of the patients aged 19 to 65 years for the risk of HIV acquisition were screened. Furthermore, the providers were asked to offer PREP to 85% of patients deemed at risk and then closely monitor those on PREP for side-effects, renal function, and sexually transmitted infections to remain compliant with the standard of care andthe evidence-based guidelines. Of a total of 32 well visits, the providers screened 29 (91%) patients. Twenty-two patients were identified to be at substantial risk, and providers offered PREP to 19 (86%) patients. Three patients agreed to take PREP, and the rest refused. The providers prescribed PREP according to the standard of care for all three (100%) patients. Results showed that using the Well Visit Forms (WVFs) and the evidence-based guidelines for PREP in the primary care setting increased the number of patients identified as at risk for HIV, increased the uptake of PREP, and assisted the providers in following the standard of care in prescribing PREP.