California Department of Public Health
Ideated, prototyped, and built a self-enrollment platform for CDPH’s PrEP Assistance Program to target geographical inaccessibility and alleviate clinical burden.
TIMELINE
July 2025 - August 2025
TOOLS
Figma, Protopie
SKILLS
Product Design
User Research
Usability Testing
TEAM
Just me, with a bit of assistance from the Klausner Lab at USC!
OVERVIEW
The California Department of Public Health (CDPH) oversees the PrEP Assistance Program (PrEP-AP), which is dedicated to providing preventative HIV medication to underinsured and uninsured patients at no cost.
Despite the apparent benefits of this program however, CDPH personnel stated that between June 2019 and June 2020, only 30 people across the entire state successfully enrolled in the program. Though enrollment has increased since, overall reported enrollment is still far from helping achieve the CDC’s goal to decrease new HIV infections to 3,000 by 2030.
In this sense, it is both within CDPH’s operational interests and mission of improving Californian health outcomes to audit the current PrEP-AP enrollment process and improve where it is weak.
INITIAL RESEARCH
Conducting Research under Special Conditions
While I was able to reach out to enrollment workers and program advisors at CDPH to gather insights on why enrollment was low, health privacy laws prevented me from finding and contacting patients directly––so I improvised!
I reached out to researchers at the USC Klausner Lab, as they had recently worked with CDPH to investigate barriers against PrEP treatment program enrollment in rural, low-income areas across Southern California. They graciously shared with me their full research manuscript, as well as direct quotes and findings from their interviews with HIV patients, giving me a much more comprehensive understanding of the issue.
Interview responses from 30+ individuals involved with PrEP-AP pointed to an outdated enrollment pipeline. This system was creating operational back-up for patients, enrollment workers, and program advisors alike.
FIGURE 1. The old PrEP-AP application process
Pain Points
On-site visits can be geographically and financially inaccessible for patients.
“I live in the Inland Empire. My closest free [HIV] testing site would be Pomona. . . ..”
(Patient, Riverside)
“That’s another deterrent for them to be, like, ‘Oh, I have to set up an appointment, I have to take time out of work, I have to drive over there.
(Patient, Los Angeles)
Delays on the patient or advisor end become the burden of enrollment workers.
“I almost feel like the enrollment worker gets the bad part of this because they’re just kind of the middleman that’s collecting papers."
(Policy Stakeholder, San Bernardino)
“[If] most of [the paperwork] can be done online, though, it’d be helpful. Because having to go to the appointment, sometimes you’ll forget things.”
(Patient, Los Angeles)
FINDINGS
The current process is good for building rapport, but not flexible and convenient enough for the world patients live in today.
Ultimately, this lack of flexibility and convenience deterred patients from successfully completing the enrollment process, even if the incentives down the line were attractive.
SOLUTION
Shifting to an efficiency-first self-enrollment model
This version of the PrEP-AP application envisions how the enrollment process could be streamlined by giving the patients more agency, but also readily-available assistance when needed.
FIGURE 2. Suggested new PrEP-AP application process
Patient-led application completion
Structured sections and conditional questions based on the patient’s circumstances allows for a straight-forward application process.
Targeted case-based assistance
Case-based ticketing system allows enrollment workers to step in when necessary, using voice call and screen sharing integrations to provide enhanced service
All-in-one patient management for enrollment workers
Consolidate and ease work burden through simplified navigation between patients
WHY NOT TELEHEALTH?
I learned after talking to the program directors that CDPH actually does partner with telehealth providers to provide PrEP-AP enrollment assistance; however, these contracts typically terminate after 2-3 years, and create a disruptance in the patients’ healthcare as new providers were being found.
Since my goal was to create a reliable, long-term solution, I opted instead to create a standardized application system that could be managed directly by the state.
PROCESS
Grounding Designs in Familiarity
CDPH does have an online enrollment system, but for a different program.
Though CDPH has no public, patient-facing online enrollment system for PrEP-AP, I found through some digging that they do have a separate, patient-facing enrollment system for individuals in need of immediate treatment, called the PrEP-AP Immediate Access Portal. This application omits all the convoluted eligibility requirements necessary for the usual application, allowing patients to obtain medication faster (albeit for a very limited period of time).
FIGURE 3. Screens from CDPH PrEP-AP Immediate Access Online Application
I used this platform as a guideline for the new layout as its familiarity would reduce the burden of enrollment for new users.
I used the official eligibility requirements to inform the application's information architecture, which also helped to standardize the application process itself.
An issue previously during enrollment was that the eligibility requirements were not made clear throughout the application––this led to numerous instances where CDPH had to reject patient applications on whim. Basing the application sections and questions off of the requirements themselves made it much easier for advisors to check-off for eligibility requirements.
DESIGNING THE PATIENT FLOW
How might we prevent backlog-causing minor errors earlier?
One of the benefits of an online application is the ability to use digital tools to automatically proofread applications for mistakes, before ever reaching the hands of an enrollment worker. Inspired by identity-verification platforms like ID.me, I sought to build checks as patients uploaded documents for eligibility parameters like name, document date, and authenticity.
Prioritizing the validity check feature
Click tracking on the document upload screen indicated that users were getting stuck upon reaching it.
This observation was corroborated by interviewee feedback that the number of choices on screen could be overwhelming for certain patients, potentially leading to indecision fatigue.
FIGURE 4. First iteration of the document validity check
KEY INSIGHT
Though the document validity check feature was beneficial in concept, the way it was implemented presently only burdened the user’s cognitive load further by creating more options for users to choose from.
Solution: Make the validity check automatic.
Good design should be unconscious and reactive, not something to be prompted. So I made the check automatic and emphasized the requirements more––using visual hierarchy to call attention to more important information.
CONNECTING THE PATIENT AND PROVIDER VIEWS
How can we cater to patients of varying age, familiarity with technology, and trust?
One of the biggest challenges throughout the design process was figuring out how to design the ideal support system for patient applicants––the UI should make it easy to request assistance from enrollment workers when necessary, but should also be simple enough for patients with low trust or high independence to navigate by themselves if need be.
I started with having personally-assigned providers for each patient, along with a ticketing system for a flexible support system that could support varied needs.
One of the biggest challenges throughout the design process was figuring out how to design the ideal support system for patient applicants––the UI should make it easy to request assistance from enrollment workers when necessary, but should also be simple enough for patients with low trust or high independence to navigate by themselves if need be.
Balancing privacy and functionality
Though the addition of a chatbox and voice-calling created easy lines of communication, they also presented an accessibility and privacy issue.
I learned from the PrEP-AP advisors that many patients already feel ashamed just for reaching out for PrEP treatment, and those that do apply to PrEP-AP are often wary of their private information being compromised. I dealt with this by adding closed captioning to the voice calls with the ability for users to decide whether to save the captions in the form of a call transcript afterwards.
FIGURE 5. Evolution through the patient-provider chat and call box
DESIGN SYSTEM
Throughout the testing and iteration process, I maintained a UI component library and several variable collections to ensure consistency across design updates.
Since PrEP-AP applicants tend to vary greatly in age, familiarity with technology, and trust, my goal with the design system was that less is more––simpler branding visually to establish professionalism and trust, with pops of color and animation to help patients navigate through the flow.
RESULT
Since this was a personal project and I was not formally contracted by CDPH to redefine the PrEP-AP enrollment process, this was ultimately left as a proof-of-concept.
However, I regularly kept in contact with the actual PrEP-AP managers and advisors throughout the process, both for exploratory research and user testing, and they told me that word of my project had sparked a larger conversation in the office of how valuable these changes would be and what it would take to convince department heads to actually fund these developments.
Ultimately, I’m grateful that I was able to take initially what was just a small, idealistic passion project of mine all the way to directors of the program itself, and that I was able to inspire a push for technological improvement in the public health sector, which is notorious for being incredibly antiquated.
If I had more time and resources…
I would’ve liked to do more extensive A/B testing on features like the ticketing system, with the goal of striking the ideal balance between privacy and functionality for the widest range of users.
POTENTIAL SUCCESS METRICS
• Number of escalated enquiries to PrEP-AP advisors (projected decrease ↓)
• Time spent completing the application (projected decrease ↓)
• Number of accepted applications within a certain timeframe (projected increase ↑)
TAKEAWAYS
Where there isn’t a path, make one
Trying to learn about PrEP-AP with its limited information online alone wasn’t enough. So I cold-messaged and cold-called public health researchers, enrollment workers, and health administrators alike until I got all the way up to PrEP-AP directors. I was able to get first-hand perspectives on things that would have been completely unavailable to me otherwise, simply due to sheer perseverance.
Lead not with a predefined process, but a north star
The lack of knowledge I had from the get-go made it impossible to follow conventional design processes and research methods, but having a clear idea of what information I needed to proceed helped inform my actions (like figuring out which people to cold-message for insight).
It’s okay to perfect as you go
No matter how much research I did before designing, I would always learn of constraints in reality from my interviewees that would force me to pivot how I approached a feature or flow. With each adaptation however, the product became more and more tailored––so just start with something, and work from there.
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