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PrEP

  • 1.  PrEP

    Posted 08-11-2020 17:26
    Greeting everyone, 

    Would you start PrEP treatment without site STD test on client with known anal and oral sex exposure? My office has been operating remotely and I have couple of clients who are willing to start PrEP.  Urine NAAT is possible but I would prefer an oropharyngeal and anal test for G/C before initiating PrEP do to known sexual history. My office is not offering self swab at this time.

    Thanks

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    Lucy Efobi, DNP, APN, FNP-BC
    Linden NJ
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  • 2.  RE: PrEP

    Posted 08-12-2020 15:15
    I would absolutely start PrEP without the STI results. As long as I have renal labs and a negative HIV test I will start them.

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    Amanda Miller
    CentroMed Santa Rosa
    San Antonio TX
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  • 3.  RE: PrEP

    Posted 08-12-2020 15:30
    I would not delay initiation of PrEP while awaiting STI testing results. If the patient is a suitable candidate for PrEP and you have access to a Negative 4th Gen HIV test, starting PrEP is fine. 

    For me STI screening is important but would not prevent me from initiating HIV Prevention. Ideally STI screening could be done elsewhere.

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    Quintin Robinson
    Absolute Care Medical Center & Pharmacy
    Atlanta GA
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  • 4.  RE: PrEP

    Posted 08-12-2020 16:03
    I would need an HIV test, pregnancy test and renal function especially for females.

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    Schevaughn Carr-Celestine
    Morris Heights Health Center
    Bronx NY
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  • 5.  RE: PrEP

    Posted 08-12-2020 16:10
    Sorry I didn't answer the question. I would start PrEP without swab STI testing. I would ask the patient if any symptoms or known exposure to GC/CT and if yes I would send treatment for both and still start PrEP.

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    Schevaughn Carr-Celestine
    Morris Heights Health Center
    Bronx NY
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  • 6.  RE: PrEP

    Posted 08-12-2020 17:13
    Thanks everyone for your response. Very helpful and informative.

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    Lucy Efobi
    Linden NJ
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  • 7.  RE: PrEP

    Posted 08-12-2020 17:20
    Good Afternoon,
    I would as long as I have a current CBC, CMP, HIV Neg, HBV results. You can assess symptoms, maybe empirically treat if symptomatic. Or send order to a lab that could do them. But they are at risk, so I say start them and obtain as soon as feasible.


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    Michael Roggelin MSN, AGNP-C, AAHIVS
    Chicago, IL
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  • 8.  RE: PrEP

    Posted 08-12-2020 19:28
    A number of free-standing lab patient service centers have aptima swabs available for patients to self-swab. I know Bioreference sites do this. Our office in NYC uses EPIC, and we can release the labs to Bioreference. Check with your local labs and your IT team, you may be able to do the same.

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    Leila Hagshenas, MD, FAAFP
    New York NY
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  • 9.  RE: PrEP

    Posted 08-12-2020 20:34
    I would suggest one of the following options.
    1.  Send the client home with swabs and requistions for throat and rectal testing.  Self collect the swabs, and turn them into the lab when they present for the blood draw.  Most labs will accept self collected swabs, BUT the lab staff can not perform the swab collection.  For example they don't swab for COVID or Flu.  
    2.  There are some resource limited setting in which the patient will swab the throat and rectum, and place the swabs in the urine sample.  The idea is that gonorrhea is gonorrhea, and chlamydia is chlamydia and the identification of the infection is the importance and since treatment is the same regardless of site, no harm.

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    John Phoenix
    Las Vegas NV
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  • 10.  RE: PrEP

    Posted 08-12-2020 22:31
    I certainly would be better to do triple site testing, but as long as you can get the standard bloodwork I would start PrEP and do triple site screening when it's possible. In my opinion, it's better to prevent the patient from getting HIV and run the risk they may be spreading gonorrhea/chlamydia than waiting until your screening is perfect.

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    Jolie LeBlanc
    NEW ORLEANS LA
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  • 11.  RE: PrEP

    Posted 08-13-2020 02:18
    Yes I would start only If I know the HIV status

    --
    Garegole Letang

    Training Lead

    Center for International Health, Education, and Biosecurity

    Maryland Global Initiatives Corporation

    Affiliate of the University of Maryland, Baltimore

    Botswana University of Maryland School of Medicine health initiatives (BUMMHI)

    Plot 70667, Fairscape Precinct, Unit 1B, 3rd Floor, Fairgrounds

    P.O. Box 203258 Bontleng

    Gaborone, Botswana

    Tel: +267 3186101

    Fax +267 3186141

    M: +267 71578283....................

    Skype: gc.letang





  • 12.  RE: PrEP

    Posted 08-13-2020 08:03
    Yes...you do need a negative hiv test and bun/creat, maybe an hiv VL if concern that the hiv test could be missing an early conversion. STD screening important in general, but not enough to not start prep.

    Sent from my iPad