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



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

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



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  • 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.
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PrEP 'n Lunch 'n Learn PrEP 'n Lunch 'n Learn Presentation Transcript

  • 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 2
  • But first, honesty please What is the first word or words that come to your mind when you think about condoms? 3 View slide
  • Honesty please What is the first word or words that come to your mind when you think about PrEP? 4 View slide
  • 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 5
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  • • 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
  • Meme by Pedro Alonso Serrano 9
  • Project RSP! in 2014 11
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  • Dateline: July 16, 2012 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
  • 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 • • Medication guide • Community education • Provider training • Implementation 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
  • 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
  • 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
  • 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
  • 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 –HIV-negative and has HIV+ partner 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
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  • 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
  • Meme by Pedro Alonso Serrano 35
  • 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
  • PrEP Truvada 37
  • 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
  • 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 with PrEP • Research (Project PrEPare) • Demo, implementation (UC and ACCESS Grand Blvd) 41
  • Accessing PrEP – Howard Brown • HBHC providers experienced with PrEP, existing patient population accessing PrEP • Dedicated adherence counselor, like case manager, for PrEP patients 42
  • 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
  • Accessing PrEP – Gilead 1. Visit 2. Click on the link to access information about Truvada for a PrEP indication 44
  • 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 45
  • New, handy brochure! Designed to help individuals talk to their doctors about PrEP Before, during, after visit Questions to ask Web resources 46
  • Groovy PrEP videos 47
  • Web resources on PrEP • • • • • • 48
  • 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 States: An Early Drug Utilization Analysis” – presented at Interscience Conference on Antimicrobial Agents and Chemotherapy, Sept ’13 • • Drug info from 55% of all US pharmacies, “nationally representative” • 49 states, 700 cities, • Algorithm to exclude treatment, PEP, offlabel Hep-B treatment 52
  • 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
  • PrEP prescriptions 54
  • 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
  • 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 only be saved by a vaccine. - Dan Savage
  • What can AFC do to support knowledge of, and access to, PrEP? 59
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  • Thank you 62