Academy Exchange

Hi everyone,

Thank you to whoever is taking the time to read this post.  My name is Michael and I'm an FNP. This has been an ongoing debate and discussion with my colleagues at our sexual health clinic and I was looking for insight and possible guidance. We serve a very large number of PrEP patients and most are adherent to their choice of PrEP (i.e Long acting injectable PrEP, daily PrEP or event driven 2-1-1). We however have a subgroup of folks in the event driven side who either do their 2-1-1 incorrectly or miss taking it all together.

In those instances, what have been your practice in navigating this issue? Clearly they are at risk of HIV due to on-going risk of current sexual activity, but as medical providers what have you all been doing in terms of refilling their medication? Which is worse: "To withhold the medication, and schedule the patient to test 2 weeks from their last sexual exposure to close out any potential risk or to continue prescribing the medication"?

What I have been doing, is counseling the patient on alternative PrEP options such as Apretude and the LAI yetsugo and trying to re-enforce adherence to their choice of PrEP while we navigate the financial coverage of better alternatives and hopefully once we are able to switch them to a better method, we can re-assess if that will promote a better HIV preventative outcome. 

Again, thank you all for your time on this :) 

-Mike Tran

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Michael Tran
Torrance CA
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I was an HIV Peer Educator in an ID clinic for two years, after our PrEP Navigator's position was vacant and the funds removed for such a position, we had 3 PrEP to positive patients. If you can get them onto an injectable PrEP option for their own safety it would be best. We found people who have issues with PrEP adherence are no better with ART. The 2 -1-1 method seems to confuse people. Other than walking them through setting a phone timer to take their meds or something simple like that you can't really help someone else to be responsible. I wish they would make an educational video of PrEP to POZ people to play for new PrEP patients. 

Not much help, but clinical insight.. 

Brooke Davidoff 

HIV Program Support Specialist Kansas City Health Dept 

Kansas City, MO.