The document discusses Pre-Exposure Prophylaxis (PrEP) as a preventive measure against HIV, highlighting its effectiveness and the target demographics that may benefit from it, including young individuals and those at higher risk. It also outlines payment options for PrEP, details a study on its adherence among a specific demographic, and explains the services offered by Philadelphia FIGHT’s PrEP program. Additionally, it provides information on community outreach strategies and the support available for individuals seeking PrEP care.

1. DEVON CLARK
P R E P R E T E N T I O N A N D A D H E R E N C E C O O R D I N A T O R
P H I L A D E L P H I A F I G H T C O M M U N I T Y H E A L T H C E N T E R S
HIV Pre Exposure Prophylaxis
OFFICE OF HIV PLANNING
12 SEPTEMBER 2016

2. What is PrEP?
 Pre Exposure Prophylaxis
 Truvada (tenofovir,
emtricitabine)
 Once daily pill that
prevents HIV
 CDC: reduces the risk of HIV
infection by up to 92%
 Effectiveness differs based on
anatomy
 PEP
 Post Exposure Prophylaxis

3. Who is PrEP for?
 Has partner(s) known to be HIV-1 infected, or
 Engages in sexual activity within a high prevalence
area or social network and one or more of the
following:
 Inconsistent or no condom use
 Diagnosis of sexually transmitted infections
 Exchange of sex for commodities (such as money, shelter,
food, or drugs)
 Use of drugs, alcohol dependence
 History of Incarceration
 Partner(s) of unknown HIV-1 status with any of the factors
listed above

4. How to Pay for PrEP?
 Gilead Advancing Access Program
 No Insurance
 Copay Assistance
 Patient Access Network
 Patient Advocate Foundation
 Covered 100% by PA Medicaid
 Biggest struggle: Young individuals who are covered by their
parents but do not what to disclose that they are receiving
care or taking PrEP

5. Gilead Sponsored PrEP Study
 50 young MSM of color and transwomen
 Adherence Counseling
 TFV Urine Assay
 Behavioral Change
 STD Rates
 Surveys

6. Study Demographics
 Age Range: 18-29
 African American: 64%
 Hispanic: 18%
 Transgender (MTF): 10%
 Annual Income <10,000: 66%
 Exchange sex for commodities: 18%
 Reports 4+ partners in the last 6 months: 30%
 History of Incarceration: 22%
 Inconsistent Condom Use: 80%

7. 0
5
10
15
20
25
30
35
40
Week 4 Week 12 Week 24
Fully
Protected
Somewhat
Protected
Not Protected
n = 43 n = 34n = 46
Urine TFV Concentrations
Week 4:
Fully Protected: 80%
Somewhat Protected: 15%
Not Protected: 4%
Week 12:
Fully Protected: 74%
Somewhat Protected: 11%
Not Protected: 14%
Week 24:
Fully Protected: 82%
Somewhat Protected: 12%
Not Protected: 5%

8. 12 6 9 64 4 2 84 1 4 2
0
2
4
6
8
10
12
14
Chlamydia
(weeks 0-
24)
Gonorrhea
(weeks 0-
24)
Chlamydia
(weeks 26-
48)
Gonorrhea
(weeks 26-
48)
Rectal
Pharyngeal
Urethral
• 2 diagnoses of Syphilis in weeks 0-24, 2 additional diagnosed in weeks
26-48
• 1 diagnosis of genital Herpes at screening
• 0 cases of trichomonas or Hepatitis C diagnosed in 48 weeks
Diagnosed STIs
Number of STI screens
performed = 231

9. 8
22
1
3
23
20
5
10
1 0
11
16
22
9
37
10 9 89
3 2
6
1 00 0
5
25
0 0
0
5
10
15
20
25
30
35
40
Significant Increase
Slight Increase
No Change
Slight Decrease
Significant Decrease
n=44
Risk and Attitude Change After 24 Weeks of PrEP

10. Philadelphia FIGHT PrEP Programs
 Where to go?
 YHEP Health Center
 Primary Care: 13-24 years old
 PrEP Care: up to age 30
 John Bell Health Center
 All care for 25 years and older
• Number of Active PrEP Patients
• YHEP Health Center: 115
• John Bell Health Center: 72

11. Philadelphia FIGHT’s PrEP Program
 Initial Visit
 Meet with a Medical Provider
 Safety Blood Work and HIV/STI Testing
 Adherence and Retention Coordinator
 Gilead Advancing Access Program
 Benefits Coordinator
 Behavioral Health Consultant
 Patient Navigation Referral

12. Philadelphia FIGHT’s PrEP Program
 Monthly Check Ups
 Opt out HIV Rapid Testing
 Medication Pick Up
 Adherence Counseling
 Risk Reduction Counseling
 Quarterly Check Ups
 Safety Blood Work and HIV/STI Testing
 Check in with a Medical Provider
 Ability to dispense PrEP weekly or biweekly
 YHEP PrEP Night

13. Outreach strategies
• Community Events
• CTR Team
• Positive Test: Linked to Care
• Negative Test: Discuss PrEP!
• Partners of people living with HIV
• PrEP Outreach Group

14. D E V O N C L A R K
Y H E P P R E P R E T E N T I O N A N D A D H E R E N C E
C O O R D I N A T O R
D C L A R K @ F I G H T . O R G
2 1 5 - 3 4 4 - 1 6 3 2
Questions?