Pilot feasibility PrEPLINKer/TestLinker project utilizes innovative blockchain technology to enhance the PrEP care continuum for underserved communities in Houston

Skyline of Houston at night.

CHPPR investigators, in collaboration with the Houston Health Department and external research institutions, have initiated a pilot project to develop and evaluate the feasibility of a blockchain-based platform to facilitate easier access to PrEP care. This community-based, interdisciplinary project uses an implementation science framework to explore future development and implementation of the PrEPLINKer system, which will assist users in overcoming barriers to PrEP access and comprehensive HIV prevention, education, and wrap-up services as well as secure management of HIV testing (TestLinker system) and risk assessment information.

The PrEPLINKer system is a pioneering application of blockchain and distributed ledger technology to the field of HIV prevention and research. Taking a patient-centered approach, this blockchain-based platform enables users to securely document their sensitive information in a smartphone wallet and share it with various healthcare providers and social services agencies they choose and trust. The interdisciplinary research team has collaborated closely with community stakeholders to develop the technological infrastructure of a peer-to-peer networking system in Houston to enhance coordination and empower an underserved community.

“This blockchain-based, patient-centered eHealth approach, focused on secured data storing and management, as well as care coordination among health organizations, holds great promise as a solution for engaging marginalized and stigmatized populations and facilitating their access to HIV prevention and comprehensive social and care services,” said Kayo Fujimoto, PhD, Principal Investigator for the project. “Ensuring privacy and confidentiality is of utmost importance, and the implementation of a secure data management and community-wide data sharing system utilizing blockchain framework paves the way for addressing barriers related to social and structural determinants of health, as well as health inequities.”

In the US, HIV disproportionately affects sexual minority men and racial/ethnic minority populations. This is especially true in the Houston/Harris County area. Due to a number of barriers, including financial instability, stigma, and lack of health insurance, these minority populations have inadequate access to HIV prevention, treatment, and social services.

Individuals in need of HIV prevention and care services often encounter the need to visit multiple different healthcare providers and social service agencies. But these disparate organizations lack a system for sharing electronic medical records or other documentation, forcing clients to use paper proof of status (including HIV status), which risks the loss of confidentiality and access if misplaced or stolen. For healthcare and community-based organizations, it can be challenging to keep track of client information across organizations to ensure seamless coordination of PrEP linkage and care services. These issues can primarily be attributed to the lack of an efficient, city-wide technological infrastructure for coordinating PrEP workflow and patient data sharing.

The proposed idea to develop a blockchain-based system and platform is intended as a solution to help clients and providers overcome these data management and technological infrastructure barriers.

“This eHealth pilot project represents a groundbreaking initiative in developing a blockchain-based platform as an implementation strategy to tackle patient-centered, integrated and coordinated care in HIV prevention within the Houston community,” said Fujimoto. “Blockchain has been used in the healthcare system before, but its application has typically not prioritized a patient-centered approach and organizational care coordination as key elements to enhance linkage to PrEP care and uptake. Our objective is to utilize these technological features and the blockchain concept of decentralized governance to promote health equity in HIV prevention and care services, working towards the reduction of new HIV infections in the U.S. and, ultimately, the achievement of ‘Ending the HIV Epidemic Initiative’ in the U.S.”

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