Podcast Summary: Optimizing Long Acting Injectable HIV Care

Becker’s Healthcare Podcast
Guests: Dr. Jackie Kissel (Director, Clinical Pharmacy, Equitas Health) & Dr. Alvin Choi (Clinical Pharmacist, LAI Program Manager, Equitas Health)
Date: December 19, 2025
Host: Lucas Vaz

Overview

This episode explores the practical, organizational, and clinical challenges of delivering long-acting injectable (LAI) HIV PrEP in outpatient settings. Dr. Jackie Kissel and Dr. Alvin Choi share their experiences at Equitas Health, detailing how multidisciplinary teams, EHR/EMR workflows, and bespoke patient-tracking solutions have enabled them to overcome operational hurdles—ultimately optimizing care for high-risk patients.

Key Discussion Points & Insights

1. Early Challenges and Pain Points (02:12–05:00)

• Lack of Clear Workflow: At program inception (circa 2021), the team faced uncertainty and chaos, not realizing the complexity of LAI PrEP beyond basic insurance approval and administration.
  • Quote: “Individuals think, oh, you get it approved by the insurance, you give an injection. Well, it’s way more complicated than that.” – Dr. Kissel [02:59]
• Fragmented Responsibility: Patients were being shuffled between different roles—providers, nurses, pharmacists—without clear tracking, leading to missed appointments and care gaps.
• Need for Dedicated Team: The realization that LAI patients need focused, coordinated oversight led to the formation of a specialized team and ultimately hiring Dr. Choi.

2. Workflow Optimization and Customized Trackers (04:24–06:46)

• Beside-the-EHR Tracking: Instead of relying solely on their EHR, the team built a custom-coded tracker system integrated with a shared calendar, detailing every patient interaction and task.
  • Quote: “We utilize a customized tracker that integrates into a calendar. This is where we operate all of our daily tasks...” – Dr. Choi [04:41]
  • The system enables real-time workload management and oversight by both leadership and front-line staff.
  • Quote: “I can look at that and see who’s getting overwhelmed with too much work. … I can ask people what’s going on…” – Dr. Kissel [06:18]

3. Insurance and Prior Authorization Process (06:46–08:21)

• Integrated Monitoring: Electronic prior authorization (ePA) databases are synchronized with the tracker to flag upcoming expirations—mitigating lapses that could endanger patient care.
  • Quote: “We use different databases to do our electronic prior authorizations … tie that into our tracker to show, okay, this prior authorization is about to expire…” – Dr. Choi [07:04]
• Medication Administration Records (MARs): Enhanced MARs are less relevant in the outpatient setting given the limited injectable inventory, but may be more used inpatient.

4. Team Collaboration and Communication (08:21–11:17)

• Cross-Department Coordination: Routine, open communication across pharmacy, billing, clinical, and insurance teams—facilitated by direct channels and regular monthly meetings—is cited as key to rapidly solving issues and continuously improving workflow.
  • Quote: “We’ve created communication channels for all of those different teams … they can just send us a message [and] someone on that team will address it…” – Dr. Kissel [09:13]
• Core Team Structure: Emphasis on maintaining a tight-knit central team to avoid confusion as volume and staff expand.
  • Quote: “Having a small knit core team is vital for this program.” – Dr. Choi [10:56]
• Direct Patient Impact: Organizational clarity ensures patients don't fall through cracks, even when unforeseen events like provider absences occur.
  • Quote: “Just for example, yesterday one of our providers was out sick. … managing where those patients are going to go, are they still going to be seen, are they still going to get their injection—all of that takes a tremendous amount of communication.” – Dr. Choi [10:28]

5. Patient Safety and the Criticality of Timely Care (11:58–14:08)

• Consequences for Missed Injections: LAI PrEP effectiveness is highly dependent on strict dosing timelines; missed or delayed injections risk serious patient harm.
  • Quote: “If [patients] aren’t on time and they acquire HIV, then you just possibly don’t have certain treatment options available…” – Dr. Kissel [12:33]
• New Options = New Hope: LAIs extend crucial flexibility and adherence support, especially for patients who struggle with daily oral PrEP regimens.
  • Quote: “Many of my patients … struggle with taking a pill every day. So having an option for a long acting injector has just literally saved their lives.” – Dr. Choi [13:10]
• Importance of Clinical Pharmacists: Their expertise in medication access, affordability, and sustained care is deemed “vital” to program success.
  • Quote: “Medication access as a pharmacist is our absolute bread and butter. … Having a clinical pharmacist on the team … is so, so vital to the success of the program.” – Dr. Choi [13:41]

Memorable Moments & Notable Quotes

| Timestamp | Speaker | Quote | |-----------|----------------|-------| | 02:59 | Dr. Kissel | “Individuals think, oh, you get it approved by the insurance, you give an injection. Well, it’s way more complicated than that.” | | 04:41 | Dr. Choi | “We utilize a customized tracker that integrates into a calendar. This is where we operate all of our daily tasks...” | | 06:18 | Dr. Kissel | “I can look at that and see who’s getting overwhelmed with too much work. … I can ask people what’s going on…” | | 07:04 | Dr. Choi | “We use different databases to do our electronic prior authorizations … tie that into our tracker to show, okay, this prior authorization is about to expire…” | | 09:13 | Dr. Kissel | “We’ve created communication channels for all of those different teams … they can just send us a message [and] someone on that team will address it…” | | 10:28 | Dr. Choi | “Just for example, yesterday one of our providers was out sick. … managing where those patients are going to go, are they still going to be seen, are they still going to get their injection—all of that takes a tremendous amount of communication.” | | 10:56 | Dr. Choi | “Having a small knit core team is vital for this program.” | | 12:33 | Dr. Kissel | “If [patients] aren’t on time and they acquire HIV, then you just possibly don’t have certain treatment options available…” | | 13:10 | Dr. Choi | “Many of my patients … struggle with taking a pill every day. So having an option for a long acting injector has just literally saved their lives.” | | 13:41 | Dr. Choi | “Medication access as a pharmacist is our absolute bread and butter. … Having a clinical pharmacist on the team … is so, so vital to the success of the program.” |

Key Takeaways

• LAI HIV PrEP delivery is complex, demanding robust tracking, a bespoke workflow beyond standard EHRs, and tight multidisciplinary communication.
• Maintaining a dedicated, core team streamlines patient tracking and ensures rapid resolution of operational challenges.
• Timeliness in dosing is not just best practice but essential for patient safety and public health, with missed injections carrying serious consequences.
• The inclusion of clinical pharmacists, with their expertise in medication navigation and access, is indispensable in this evolving care landscape.
• Ultimately, rigorous processes and strong collaboration are about safeguarding and improving the patient experience while advancing innovative HIV prevention.

For more episodes, visit Becker’s Healthcare Podcast at beckershospitalreview.com.