PrEP ‘n Lunch ‘n Learn 1.22.14

Meme by Pedro Alonso Serrano

Jessica Terlikowski and Jim Pickett
Your PrEP Squad
Today
• Project RSP!

• What is PrEP?
• What does/doesn’t
it do?
• How do you get it?

• Why is it important?
• PrEP’n AFC...
But first, honesty please

What is the first word or
words that come to your
mind when you think
about condoms?
3
Honesty please

What is the first word or
words that come to your
mind when you think
about PrEP?
4
Unrestricted
educational
grant from
Gilead for
2013

• Trainings: Help Chicago providers, educators, and others
working di...
6
7
• We are NOT “pushing” PrEP
• We are NOT telling anyone to stop using
condoms or other forms of protection

• We are pushi...
Meme by Pedro Alonso Serrano
9
Project RSP! in 2014

11
12
Dateline: July 16, 2012
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312210.htm

Today, the US Food and Dr...
Dateline: July 16, 2012
• Truvada is approved for use as part of a comprehensive HIV
prevention strategy that includes oth...
How did we get here?
• All completed trials done on tenofovir &
Truvada
• 4 trials = PrEP reduced risk of HIV infection
– ...
Bumps in the road for women
• 2 trials = PrEP did not work
– FEM-PrEP (Truvada in women – stopped
2011)
– VOICE (Truvada, ...
Key research findings
• Adherence! Adherence! Adherence! (take
the pill every day… every day means every
day…)
• High adhe...
Key research findings
• For some, there appears to be a general
“start-up syndrome” w/Truvada that
includes nausea, diarrh...
Why would someone
want to take PrEP?

19
Who might be a good fit for PrEP?

• Person indicates an interest in taking PrEP
• Person is in a “magnetic” relationship
...
Who might be a good fit for PrEP?
• Sexual activity within high prevalence area or
social network, and/or:
– Doesn’t use m...
22
What about…
23
SEX
pleasure
intimacy
connection
emotion
lust

love
Honesty please

What is the first word or
words that come to your
mind when you think
about PrEP?
26
DANGER
RISK
SHAME
Meme by Pedro Alonso Serrano
35
PrEP takes work
• Truvada as PrEP means…
– A daily pill
– On-going engagement with
healthcare
• Quarterly HIV testing
• Ad...
PrEP

Truvada

37
PrEP aint magic
• Truvada as PrEP does not
– Guarantee 100% protection from HIV (what does?)
– Protect a person against ot...
Seat belts aint perfect

39
How do you get
PrEP?

40
Accessing PrEP
• Any doctor who can write a
prescription can write one
for Truvada as PrEP
• Most HIV docs are familiar
wi...
Accessing PrEP – Howard Brown

• HBHC providers
experienced with PrEP,
existing patient
population accessing
PrEP
• Dedica...
Accessing PrEP— insurance
FDA approval of
Truvada enables
private ins to cover

Truvada
on
Medicaid
formulary

ADAP
does n...
Accessing PrEP – Gilead
1. Visit
www.truvada.com
2. Click on the link to
access information
about Truvada for a
PrEP indic...
Clinical Practice Guidelines
•
•
•
•

Interim guidelines for different pops already available
Final guidelines being draft...
New, handy brochure!
Designed to help individuals talk to
their doctors about PrEP
Before, during, after visit
Questions...
Groovy PrEP videos

WhatisPrEP.org
tinyurl.com/PrEPbyKLB
47
Web resources on PrEP

•
•
•
•
•
•

MyPrEPexperience.blogspot.com
Truvada.com
ProjectInform.org/prep
PrEPWatch.org
PrEPfac...
Be PrEPared
for the unPrEPared

49
Meme by Pedro Alonso Serrano
50
Snapshot of PrEP
prescriptions

51
PrEP prescriptions – how many, who?
• “Status of Truvada (TVD) for HIV Pre-Exposure
Prophylaxis (PrEP) in the United State...
PrEP prescriptions
• 1,774 unique PrEP users between
January 2011 and March 2013 (starting
before FDA approval)
• 1,674 pr...
PrEP prescriptions

54
PrEP prescriptions
• Approx. half of all Rx were started before
FDA approval in summer 2012
• Approx. half of all Rx writt...
Meme by Pedro Alonso Serrano
56
The only important
thing to know and
do is always wear a
condom.
- Larry Kramer
The guys these sensible
health care folks are trying to
reach are not sensible. They
are self-identified idiots who
can on...
What can AFC do
to support
knowledge of,
and access to,

PrEP?
59
60
61
Thank
you

62
PrEP 'n Lunch 'n Learn
PrEP 'n Lunch 'n Learn
PrEP 'n Lunch 'n Learn
PrEP 'n Lunch 'n Learn
PrEP 'n Lunch 'n Learn
PrEP 'n Lunch 'n Learn
PrEP 'n Lunch 'n Learn
PrEP 'n Lunch 'n Learn
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PrEP 'n Lunch 'n Learn

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Presentation on PrEP done as part of AIDS Foundation of Chicago's "Lunch 'n Learn" series.

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  • Jim and/or Jessica
  • .
  • Jim and/or Jessica
  • Jim and/or Jessica
  • Sybil
  • Sybil
  • Jim and/or Jessica
  • Jim and/or Jessica
  • Jim and/or JessicaWe will write these down on flipcharts. The goal from this exercise is to name some of the opinions, attitudes, and feelings re: PrEP. We are starting with condoms because they are much less charged a subject.
  • Staci
  • Sybil
  • Staci
  • Staci
  • Switch over to Staci
  • Staci
  • Staci
  • Sybil and Staci – other sites to add?
  • PrEP 'n Lunch 'n Learn

    1. 1. PrEP ‘n Lunch ‘n Learn 1.22.14 Meme by Pedro Alonso Serrano Jessica Terlikowski and Jim Pickett Your PrEP Squad
    2. 2. Today • Project RSP! • What is PrEP? • What does/doesn’t it do? • How do you get it? • Why is it important? • PrEP’n AFC 2
    3. 3. But first, honesty please What is the first word or words that come to your mind when you think about condoms? 3
    4. 4. Honesty please What is the first word or words that come to your mind when you think about PrEP? 4
    5. 5. Unrestricted educational grant from Gilead for 2013 • Trainings: Help Chicago providers, educators, and others working directly with our community to understand PrEP and what it means for us and HIV prevention. • Community forums: Interactive and fun discussions done “talk show” style • Give voice/provide facts: Platform for PrEP users to share experiences, interested individuals to get info – click myprepexperience.blogspot.com. 5
    6. 6. 6
    7. 7. 7
    8. 8. • We are NOT “pushing” PrEP • We are NOT telling anyone to stop using condoms or other forms of protection • We are pushing education • Knowledge is power • Ignorance is not strength 8
    9. 9. Meme by Pedro Alonso Serrano 9
    10. 10. Project RSP! in 2014 11
    11. 11. 12
    12. 12. Dateline: July 16, 2012 http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312210.htm Today, the US Food and Drug Administration approved Truvada (emtricitabine/tenofovir disoproxil fumarate), the first drug approved to reduce the risk of HIV infection in uninfected individuals who are at high risk of HIV infection and who may engage in sexual activity with HIVinfected partners. 13
    13. 13. Dateline: July 16, 2012 • Truvada is approved for use as part of a comprehensive HIV prevention strategy that includes other prevention methods, such as safe sex practices, risk reduction counseling, and regular HIV testing. - FDA – Must be confirmed HIV-negative before prescription – FDA required development of Risk Evaluation and Mitigation Strategy (REMS) for use of Truvada as PreP to ensure safe use • www.truvadapreprems.com • Medication guide • Community education • Provider training • Implementation 14
    14. 14. How did we get here? • All completed trials done on tenofovir & Truvada • 4 trials = PrEP reduced risk of HIV infection – i-PrEX (Truvada in gay men and trans women) – Partners PrEP (Truvada and tenofovir in heterosexual couples) – TDF2 (Truvada heterosexual men & women) – Bangkok Tenofovir Study (injection drug users) 15
    15. 15. Bumps in the road for women • 2 trials = PrEP did not work – FEM-PrEP (Truvada in women – stopped 2011) – VOICE (Truvada, tenofovir – reported 2013) • Both trials had very low adherence – (though self-reports were high) • Both trials found low/undetected drug levels 16
    16. 16. Key research findings • Adherence! Adherence! Adherence! (take the pill every day… every day means every day…) • High adherence achieved 90%+ reduction in risk • Truvada PrEP trials to date have not shown increases in sexual risk behavior among participants • Across all PrEP studies of Truvada, there have been no serious safety problems 17
    17. 17. Key research findings • For some, there appears to be a general “start-up syndrome” w/Truvada that includes nausea, diarrhea, abdominal pain and headaches. • Nausea most common (under 10%) and resolved in 4 to 6 weeks • Very little drug resistance has been seen, only among those with unidentified HIV infection when they started the study 18
    18. 18. Why would someone want to take PrEP? 19
    19. 19. Who might be a good fit for PrEP? • Person indicates an interest in taking PrEP • Person is in a “magnetic” relationship –HIV-negative and has HIV+ partner 20
    20. 20. Who might be a good fit for PrEP? • Sexual activity within high prevalence area or social network, and/or: – Doesn’t use male or female condoms consistently – Diagnosed with STI(s) – Exchanges sex for money, food, shelter, drugs, etc. – Uses illicit drugs or depends on alcohol – Is or has been incarcerated – Does not know partner’s HIV status and one of the above factors is true for partner 21
    21. 21. 22
    22. 22. What about… 23
    23. 23. SEX
    24. 24. pleasure intimacy connection emotion lust love
    25. 25. Honesty please What is the first word or words that come to your mind when you think about PrEP? 26
    26. 26. DANGER RISK SHAME
    27. 27. Meme by Pedro Alonso Serrano 35
    28. 28. PrEP takes work • Truvada as PrEP means… – A daily pill – On-going engagement with healthcare • Quarterly HIV testing • Adherence support/counseling • Regular STD screening and treatment • Tests for toxicities, bone density 36
    29. 29. PrEP Truvada 37
    30. 30. PrEP aint magic • Truvada as PrEP does not – Guarantee 100% protection from HIV (what does?) – Protect a person against other STIs like chlamydia, syphilis, herpes, or gonorrhoea – Prevent pregnancy – Cure HIV – Function as a treatment regimen for someone already living with HIV. 38
    31. 31. Seat belts aint perfect 39
    32. 32. How do you get PrEP? 40
    33. 33. Accessing PrEP • Any doctor who can write a prescription can write one for Truvada as PrEP • Most HIV docs are familiar with PrEP • Research (Project PrEPare) • Demo, implementation (UC and ACCESS Grand Blvd) 41
    34. 34. Accessing PrEP – Howard Brown • HBHC providers experienced with PrEP, existing patient population accessing PrEP • Dedicated adherence counselor, like case manager, for PrEP patients www.howardbrown.org 42
    35. 35. Accessing PrEP— insurance FDA approval of Truvada enables private ins to cover Truvada on Medicaid formulary ADAP does not cover PrEP Ins companies covering, so far 43
    36. 36. Accessing PrEP – Gilead 1. Visit www.truvada.com 2. Click on the link to access information about Truvada for a PrEP indication 44
    37. 37. Clinical Practice Guidelines • • • • Interim guidelines for different pops already available Final guidelines being drafted – expect to publish soon For clinicians – not “all purpose” Includes info on evidence, guidelines for screening, providing PrEP to gay men and heterosexuals, discontinuing PrEP, clinical considerations, improving adherence, reducing risk behaviors, info on financial case management, fact sheets, risk index, counseling info, and quality measures • Remember the REMS www.truvadapreprems.com 45
    38. 38. New, handy brochure! Designed to help individuals talk to their doctors about PrEP Before, during, after visit Questions to ask Web resources http://www.cdc.gov/hiv/pdf/risk_PrEP_TalkingtoDr_FINALcleared.pdf 46
    39. 39. Groovy PrEP videos WhatisPrEP.org tinyurl.com/PrEPbyKLB 47
    40. 40. Web resources on PrEP • • • • • • MyPrEPexperience.blogspot.com Truvada.com ProjectInform.org/prep PrEPWatch.org PrEPfacts.org WhatisPrEP.org 48
    41. 41. Be PrEPared for the unPrEPared 49
    42. 42. Meme by Pedro Alonso Serrano 50
    43. 43. Snapshot of PrEP prescriptions 51
    44. 44. PrEP prescriptions – how many, who? • “Status of Truvada (TVD) for HIV Pre-Exposure Prophylaxis (PrEP) in the United States: An Early Drug Utilization Analysis” – presented at Interscience Conference on Antimicrobial Agents and Chemotherapy, Sept ’13 • http://www.natap.org/2013/ICAAC/ICAAC_18.htm • Drug info from 55% of all US pharmacies, “nationally representative” • 49 states, 700 cities, • Algorithm to exclude treatment, PEP, offlabel Hep-B treatment 52
    45. 45. PrEP prescriptions • 1,774 unique PrEP users between January 2011 and March 2013 (starting before FDA approval) • 1,674 prescribers (620 also prescribed Truvada as Tx) 53
    46. 46. PrEP prescriptions 54
    47. 47. PrEP prescriptions • Approx. half of all Rx were started before FDA approval in summer 2012 • Approx. half of all Rx written for female PrEP users • Largest percentage Rx written in the Southeast • Average age of PrEP users + 35 yrs • Approx. 13% of users since FDA approval are under the age of 25 55
    48. 48. Meme by Pedro Alonso Serrano 56
    49. 49. The only important thing to know and do is always wear a condom. - Larry Kramer
    50. 50. The guys these sensible health care folks are trying to reach are not sensible. They are self-identified idiots who can only be saved by a vaccine. - Dan Savage
    51. 51. What can AFC do to support knowledge of, and access to, PrEP? 59
    52. 52. 60
    53. 53. 61
    54. 54. Thank you 62

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