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HIV Pre Exposure Prophylaxis

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Philadelphia FIGHT's PrEP Retention and Adherence Coordinator Devon Clark presented on HIV Pre-exposure Prophylaxis (PrEP) at the September 2016 meeting of the Positive Committee.

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HIV Pre Exposure Prophylaxis

  1. 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. 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. 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. 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. 5. Gilead Sponsored PrEP Study  50 young MSM of color and transwomen  Adherence Counseling  TFV Urine Assay  Behavioral Change  STD Rates  Surveys
  6. 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. 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. 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. 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. 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. 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. 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. 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. 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?

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