Academy Exchange

  • 1.  Practical steps with On Demand PrEP

    Posted 09-16-2021 09:57
    Curious if other practitioners have suggestions on practical steps with prescribing On Demand PrEP? 

    The majority of patients I see on PrEP take it daily and we do 90d refills with expectation that they return every 90d for testing.  If they have not come back for labs the refill request serves as a trigger to reach out to them and get testing done. 

    Do we still expect them to do every 90d testing with On Demand PrEP? 
    What quantity of tablets do you typically prescribe for patient using PrEP on demand? I would image patients with a 90d supply who are not taking it daily might not return for testing for q90d if they have plenty of pills left.  

    Any practical recommendations for monitoring and supporting those choosing On Demand PrEP would be appreciated.

    Best,
    Jarrett

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    Jarrett Sell, MD FAAFP AAHIVS
    Penn State Health /Alder Health
    Harrisburg PA
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  • 2.  RE: Practical steps with On Demand PrEP

    Posted 09-16-2021 22:28
    I have been prescribing only 28 tablets at a time without refills for my folks with rare sexual encounters. Essentially that will cover 7 instances per year. I also tell them that at a minimum we should be checking HIV every 6 months (to mitigate loss to follow up) or at every refill. It may be worth reducing that number or increasing it based on frequency so that folks aren't going years on PrEP without appropriate testing.

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    Benjamin Sokoloff, DO
    Cascade AIDS Project | Prism Health
    Portland OR
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  • 3.  RE: Practical steps with On Demand PrEP

    Posted 09-16-2021 23:44
    Hello! I only prescribe 30 days (one bottle) worth of Truvada with instructions to follow up every 6 months or when the bottle is out for repeat testing… this way I can gauge the amount of use and still have them come back.I also find yearly physical exams are helpful to prevent the "lost to follow up" patients by having those scheduled automatically each year ahead of time! I think this is a great question to see how everyone else handles this since it's always been a question in the back of my head…

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    Randy Gelow
    Phoenix AZ
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