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Promoting PrEP and PEP

  • 1.  Promoting PrEP and PEP

    Posted 03-26-2020 16:44
    Hello fellow HIV community members.

    Just wondering if you could share some thoughts about your experiences on how to promote PrEP and PEP in your fields of practice. What has worked and which approach was less effective. In my experience I have noticed that, for obvious reasons, when it comes to PEP people seem to be more accepting of the recommended available treatment but PrEP seems to be a harder sell, especially when it comes to extended compliance. And, are you seeing more TAF vs TDF use already?

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    Sevak Olmessekian, RPh, AAHIVP
    GlendaleCA
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  • 2.  RE: Promoting PrEP and PEP

    Posted 03-27-2020 09:11
    ​Good Morning folks: Sevak, interesting discussion point.  Most of our PrEP discussions actually go very well, especially when patients recognize cost coverage is relatively easy.  Many people were very excited about TAF options, but the prohibitions for women and the newer whispers of weight gain have tempered that some.  I welcome more discussion, many thanks, Mark Goodman

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    Mark Goodman
    Omaha NE
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  • 3.  RE: Promoting PrEP and PEP

    Posted 03-28-2020 02:02
    Thank you Mark for your reply. I also have noticed that once the weight gain discussion comes up people seem to have this disappointed look and cringe. From what has been pointed out to me by a drug rep the weight gain is pretty minimal ( no more than a few pounds), and also the studies so far do not really show a clear advantage for switching to TAF, especially when considering the generic TDF is in the near horizon. So unless someone has kidney function or bone density considerations, is there really any advantage to consider TAF for PrEP? This is a discussion I have had with some patients.

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    Sevak Olmessekian
    GlendaleCA
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  • 4.  RE: Promoting PrEP and PEP

    Posted 03-28-2020 14:32
    In our area we have "demedicalized" PrEP. PharmDs can not diagnose. PrEP eligibility doesn't require a diagnosis. We do rapid PrEP starts and routine PrEP follow ups with a PharmD. Patients must be examined at least one time a year by a MD or NP. Of course if problems arise they can be seen by an MD or NP. We have found great success in both initiation and persistence on PrEP. A lot of the problems people face when it comes to PrEP adherence arise after they obtain the prescription. They have problems at the pharmacy. The pharmacy may have problems understanding the difference between copay cards and patient assistance cards. 

    Kandis V. Backus, PharmD, MS, AAHIVP 
    Jackson, MS

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    Kandis Backus
    Jackson MS
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  • 5.  RE: Promoting PrEP and PEP

    Posted 03-28-2020 14:58
    Thank you Kandis for highlighting the pharmacy aspect. I practice in a specialty pharmacy setting and I feel like sometimes we take the training and the resources available to us for granted. At our practice setting we are constantly updated on the a variety of payment avenues available for prescription coverage for specialty medications, as well as having sufficient inventory of specialty medications. As a specialty setting we have the advantage of more focused pharmacy services compared to a regular retail setting. There have been instances where a patient has requested to pick up their medication at their local retail store and during the transfer process I realized that the pharmacy staff is not even familiar with the medication, and therefore not properly trained for counseling and let alone familiar with the available payment coverage options. Perhaps a patient would be better served if as least the initial consultation and the first time fill of their PrEP medication is provided through a specialty pharmacy by someone who is better versed in these medications and disease state.

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    Sevak Olmessekian
    GlendaleCA
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  • 6.  RE: Promoting PrEP and PEP

    Posted 03-29-2020 11:17
    Hi Kandis, 
    are patients getting lab tests (HIV testing, renal function, UA, LFTs, Hep B serologies, etc.) at the pharmacy, or are they bringing some test results with them? I'm asking because California is set to start allowing pharmacists to dispense an initial 60 days of medication without a prescription, but the pharmacists I've spoken with don't feel comfortable without prescriber back up. Locally this is going to cause us a delay in implementation.

    thanks,
    Edie Saville, NP
    San Diego, CA

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    Edith Saville
    San Diego CA
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  • 7.  RE: Promoting PrEP and PEP

    Posted 03-29-2020 12:28
    I should have provided more information. Thank you for asking the question. 1. I don't work in a pharmacy I am clinic based. 2. We rely on our community partners as well as the MS Dept. of Health(MSDH). Our community partners do rapid HIV testing for initial PrEP starts. MSDH pays for the follow up testing and other labs such as serum creatinine, HCV/HBV, pregnancy test, and other STIs. The results from community partners are communicated via fax. MSDH uses the same EHR as the Medical Center that employees me so I can see their labs. I also am able to order labs for people to get at various County health department. We currently provide PrEP to most of the state.

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    Kandis Backus
    Jackson MS
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