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Chicago Department of Public Health Besly Court 9.11.15
Download these slides here: tinyurl.com/PrEPSept1115
Funding for t...
• Who’s in the room?
• Pre and post test, evaluation
• Overview ARV-based prevention
• Understanding PrEP
– What is PrEP?
...
3
Please like, follow us on Facebook
facebook.com/ProjectRSP
tinyurl.com/ChicagoPrEPforum
4
Ground rules
• We are all somewhere on
the learning curve
• Participate to the fullest of
our abilities
• The only dumb qu...
6
Who’s
in the
room?
7
Logistics
8
What is the first word or
words that come to your
mind when you think
about condoms?
10
What is the first word or
words that come to your
mind when you think about
needle exchange?
11
What is the first word or
words that come to your
mind when you think about
oral contraceptives?
12
What is the first word or
words that come to your
mind when you think
about PrEP?
13
What is ARV-based prevention?
• Strategies that use HIV treatment
drugs (antiretrovirals or “ARVs”) to
prevent HIV infecti...
16
17
Condom use and effectiveness
18
JAIDS 2014
Condom Effectiveness for HIV Prevention by Consistency of Use Among MSM in
the ...
19
AJPH 1998
Variables influencing condom use in a cohort of gay and bisexual men
• 23 per cent of the men reported that t...
First, what is prophylaxis?
• Prophylaxis is simply the provision of
medications prior to germ or virus
exposure to preven...
What is PrEP?
• PrEP consists of taking the ARV drug Truvada to
prevent HIV
• Truvada is a combination of tenofovir disopr...
23
#HIV2020
AIDS.gov/2020
24
25
#HIV2020
AIDS.gov/2020
Approved Truvada for PrEP
Gay/straight men, women 18+
July 16, 2012
27
tinyurl.com/CDCprepguidelines
tinyurl.com/CDCprepguidelineswebinar
May 14, 2014
PrEP Clinical Practice Guidelines
• For clinicians
– But incredibly useful for providers, educators, policy
folks, and adv...
30
WhatIsPrEP.org
31
32
• True or False: PrEP must be started within 72 hours
of exposure to HIV.
• The FDA approved Truvada as PrEP in what ye...
www.myprepexperience.org
34
PrEP works – the science
• 6 trials = PrEP reduced risk of HIV infection
– i-PrEX (Truvada in gay men and trans women)
– P...
Bumps in the road for women
• 2 trials = PrEP did not work
– FEM-PrEP (Truvada in women –
stopped 2011)
– VOICE (Truvada, ...
PrEP works – key findings
• Adherence!
• High adherence achieved 90%+
reduction in risk
• Truvada PrEP trials to date have...
• Some will experience a general “start-up
syndrome” w/Truvada that includes nausea,
diarrhea, abdominal pain and headache...
PrEP side effects
• 1 in 10 will have nausea that
subsides quickly.
• 1 in 100 will experience bone
density loss, which pl...
40
I don't have any regrets, but what I do
have is peace of mind. And that is exactly
what I was looking for with this
medica...
42
43
44
45
46
• Kaiser Permanente PrEP
program in San Francisco
• Provides services to over
170,000 adults in SF
• Study period:
July ‘1...
• No HIV diagnoses during
388 person-years of f/u
• 143 completed survey on
behavior change
– Number sexual partners
• # U...
49
50
51
52
www.ias2015.org
www.aidsmap.com/ias2015
53
www.ias2015.org
www.aidsmap.com/ias2015
54
www.ias2015.org
www.aidsmap.com/ias2015 Dr. Sybil Hosek – CORE
www.aidsmap.com/ias2015
• ATN 110
• 12 U.S. cities, including Chicago
• 200 gay (77.8%) and bi (13.7%) men, 18 – 22 (mean ...
56
www.ias2015.org
www.aidsmap.com/ias2015 Dr. Al Liu – SF DPH
57
• PrEP Demo Project
• SF, DC and Miami
• 557 particps; median age 35
• 48% White; 35% Latino;
7% Black; 10% other
• 98%...
58
Chicago PrEP Research
Chicago PrEP research/CORE
• Project PrEPare II
• Open label demonstration project AND safety study
of PrEP in young gay/M...
Chicago PrEP research/CORE
• Enhancing PrEP in Communities (EPIC)
• To test the effectiveness of Prepmate, a novel multi-
...
61
62
PrEP is more than a prescription
PrEP is a
program
 Take Truvada every day
 Provider* visits every 3 mos
 HIV testing every 3 mos
 Tied to Rx renewal
 Hepatitis B testi...
 Adherence counselling
 Perfection not required, especially for
rectal exposure
 Take 5 – 7 days before
enough drug is ...
66
• iPrEX Open Label
• 1,603 participants, 1,225 on PrEP
• Most from Peru/Ecuador, 18% USA
• 100% effectiveness associated
w...
What PrEP does not do
• Truvada as PrEP does not
– Guarantee 100% protection from HIV (what
does?)
– Protect a person agai...
69
70
• True or False: PrEP does not work for women.
• True or False: About 25% of people who take
PrEP will have nausea.
• T...
71
tinyurl.com/ChicagoPrEPforum
72
www.myprepexperience.org
Who might be a good fit for PrEP?
•Person indicates an
interest in taking PrEP
75
Who might be a good fit for PrEP?
• Person is in a “magnetic” relationship
–HIV-negative and has HIV+ partner who is
not o...
Who might be a good fit for PrEP?
• Male, female, transgender person engaging in sexual
activity within high prevalence ar...
PrEP-C
pleasure
intimacy
connection
emotion
lust
love
80
In this sample of men
who are in a
relationship with a
perceived HIV-negative
man, we found that
intimacy motivation wa...
81
Reclaim
pleasure
82
84
Accessing PrEP in Chicago
• Any medical provider who can
write a scrip can write one for
Truvada as PrEP
• tinyurl.com/Chi...
86
PrEP at CORE
PrEP Access –The CORE program
87
• HEAT – Helping Eliminate AIDS through
Teamwork
• Health Educators are first line for Pr...
PrEP Access –The CORE program
88
• Primary clinic location: CORE Center
– Monday afternoons for youth under 25
– Tuesday e...
PrEP Access –The CORE program
89
• Initial screening appointment in PrEP
clinic will include Rx if necessary lab
tests are...
91
Uninformed, misinformed providers
92
93
Handy brochure
94
Designed to help individuals talk to
their doctors about PrEP
Before, during, after visit
Questions to...
95
PrEPline, 855-448-7737
The CCC Pre-Exposure Prophylaxis Service
11 a.m. – 6 p.m. EST
http://nccc.ucsf.edu/2014/09/29/in...
• MyPrEPexperience.org
• Chicago PrEP Line - (872) 215-1905
hivelimination.uchicago.edu/projects/programs/prep_hotline_lin...
www.facebook.com/groups/PrEPFacts
97
98
PositivelyAware.com
Printed copies available
email distribution@tpan.com
99
100
Please like, follow us on Facebook
facebook.com/ProjectRSP
FDA approval of
Truvada enables
private ins to cover
Medicaid
formulary
Ins companies
covering, so far
ADAP does
not cover...
 Drug costs
 Visit, service costs
 Lab costs
103
104
the devil is in the details
 Premiums
 Deductibles
 Cost-sharing
 Drug formularies
 Drug tiers
 Shifting benefit...
105
http://ow.ly/PTYCK
Paying for PrEP – Gilead
1. Visit
www.truvada.com
2. Click on the link to
access information
about Truvada for a
PrEP indi...
Medication Assistance Program
• Gilead will provide Truvada for PrEP at no cost for
individuals who qualify for the assist...
Co-pay card program
Covers all Gilead HIV Products: Stribild, Complera,
Atripla, Truvada, Viread, Emtriva
• Assists patien...
109
• www.panfoundation.org/hiv-treatment-and-prevention
• Accepting applications for new and renewal patients. If
applica...
110
111
USCA 2014
112
113
www.ias2015.org
[Quote from female sex worker participating in treatment
and PrEP demo project in Johannesburg, South ...
114
115
• How can people pay for their PrEP
prescriptions?
• People taking PrEP need to be tested for HIV
_____ times every ye...
117
118
“Party drug”
“Public health disaster”
119PrEP DENIALISM
120
121
Condom privilege
122
“But ARVs are toxic…”
123
Tips for talking about PrEP
• You need not be an expert.
• Though, it’s important you feel comfortable talking
about PrEP....
Tips for talking about PrEP
• As a provider, you are viewed as a trusted source
of information.
• Remember any perspective...
Messages to emphasize to clients
• PrEP is an accessible option
– Not forever, but maybe for a “season”
– If you use condo...
THOUGHTFUL
RESPONSIBLE
CAREFUL
128
AWARE
PRO-ACTIVE
DISCIPLINED
TAKING PREP IS
SAFER SEX
TAKING PREP IS
129
PrEP elevator speech
• You get in the elevator at the 95th floor with
someone who has just asked you about PrEP.
You have ...
131
132
"Interventions do not just work automatically,
they have to be made to work – and people have
responsibility for makin...
tinyurl.com/ChicagoPrEPforum
133
134
Open access
http://www.jiasociety.org/index.php/jias/issue/view/1474
135
136
Thank you!!
137
138
139
CONTACT
Jim Pickett
jpickett@aidschicago.org
Sybil Hosek
sybilhosek@gmail.com
140
#yayPrEP
Download these slides:
tinyurl....
Project RSP Training on PrEP - September 11, 2015
Project RSP Training on PrEP - September 11, 2015
Project RSP Training on PrEP - September 11, 2015
Project RSP Training on PrEP - September 11, 2015
Project RSP Training on PrEP - September 11, 2015
Project RSP Training on PrEP - September 11, 2015
Project RSP Training on PrEP - September 11, 2015
Project RSP Training on PrEP - September 11, 2015
Project RSP Training on PrEP - September 11, 2015
Project RSP Training on PrEP - September 11, 2015
Project RSP Training on PrEP - September 11, 2015
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Project RSP Training on PrEP - September 11, 2015

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This training was conducted by AIDS Foundation of Chicago for members of Chicago's HIV workforce - in partnership with the Chicago Department of Public Health. It took place on Friday, September 11, 2015. Presenters included the CORE Center's Dr. Sybil Hosek, Jim Pickett of AFC, and Gabe Bahena, a PrEP consumer. .

Published in: Health & Medicine
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Project RSP Training on PrEP - September 11, 2015

  1. 1. Chicago Department of Public Health Besly Court 9.11.15 Download these slides here: tinyurl.com/PrEPSept1115 Funding for this training provided by Gilead Sciences
  2. 2. • Who’s in the room? • Pre and post test, evaluation • Overview ARV-based prevention • Understanding PrEP – What is PrEP? – How PrEP is taken – Access to PrEP – BREAKING NEWS – And more… These slides available at: tinyurl.com/PrEPSept1115
  3. 3. 3 Please like, follow us on Facebook facebook.com/ProjectRSP
  4. 4. tinyurl.com/ChicagoPrEPforum 4
  5. 5. Ground rules • We are all somewhere on the learning curve • Participate to the fullest of our abilities • The only dumb questions are the ones not asked 5
  6. 6. 6 Who’s in the room?
  7. 7. 7 Logistics
  8. 8. 8
  9. 9. What is the first word or words that come to your mind when you think about condoms? 10
  10. 10. What is the first word or words that come to your mind when you think about needle exchange? 11
  11. 11. What is the first word or words that come to your mind when you think about oral contraceptives? 12
  12. 12. What is the first word or words that come to your mind when you think about PrEP? 13
  13. 13. What is ARV-based prevention? • Strategies that use HIV treatment drugs (antiretrovirals or “ARVs”) to prevent HIV infection – TLC+ (testing, linkage to care, plus treatment) – ARV-based microbicides – PEP (post-exposure prophylaxis) – PrEP (pre-exposure prophylaxis) 15
  14. 14. 16
  15. 15. 17
  16. 16. Condom use and effectiveness 18 JAIDS 2014 Condom Effectiveness for HIV Prevention by Consistency of Use Among MSM in the U.S. • Data from EXPLORE and VAX 004 • 16.4% reported “always” using condoms during anal sex • 70% overall effectiveness • Inconsistent use, “sometimes” use, offers minimal to no protection over time
  17. 17. 19 AJPH 1998 Variables influencing condom use in a cohort of gay and bisexual men • 23 per cent of the men reported that they always used condoms for IAI and 21 per cent for RAI • 32 per cent sometimes used condoms for IAI • 28 per cent sometimes used condoms for RAI • 45 per cent never used condoms for IAI • 50 per cent never used condoms for RAI Condom use and effectiveness
  18. 18. First, what is prophylaxis? • Prophylaxis is simply the provision of medications prior to germ or virus exposure to prevent infection. • This is not a new concept. • This is not a new practice. • Example: taking malaria drugs before traveling to countries with high malaria incidence • What are examples of similar concepts? 21
  19. 19. What is PrEP? • PrEP consists of taking the ARV drug Truvada to prevent HIV • Truvada is a combination of tenofovir disoproxil fumarate (aka tenofovir or TDF) and emtricitabine. • Need to take 5 – 7 days of Truvada before enough drug is “on board” for protection in rectum. • Three weeks for vaginal protection. • Truvada is currently the only drug approved by the FDA for PrEP. 22
  20. 20. 23 #HIV2020 AIDS.gov/2020
  21. 21. 24
  22. 22. 25 #HIV2020 AIDS.gov/2020
  23. 23. Approved Truvada for PrEP Gay/straight men, women 18+ July 16, 2012
  24. 24. 27 tinyurl.com/CDCprepguidelines tinyurl.com/CDCprepguidelineswebinar May 14, 2014
  25. 25. PrEP Clinical Practice Guidelines • For clinicians – But incredibly useful for providers, educators, policy folks, and advocates – YOU • Includes info on efficacy and safety evidence, guidelines for screening, providing PrEP to gay men, heterosexuals, and injection drug users, discontinuing PrEP, clinical considerations, improving adherence, reducing risk behaviors, info on financial case management, fact sheets, risk index, counseling info, and quality measures 28tinyurl.com/CDCprepguidelines
  26. 26. 30 WhatIsPrEP.org
  27. 27. 31
  28. 28. 32 • True or False: PrEP must be started within 72 hours of exposure to HIV. • The FDA approved Truvada as PrEP in what year? • True or False: People on PrEP should be tested for HIV every month. • True or False: It takes longer for PrEP to achieve protection in the vagina compared to the rectum.
  29. 29. www.myprepexperience.org
  30. 30. 34
  31. 31. PrEP works – the science • 6 trials = PrEP reduced risk of HIV infection – i-PrEX (Truvada in gay men and trans women) – Partners PrEP (Truvada and tenofovir in heterosexual couples) • TDF/FTC combination and Tenofovir alone comparably efficacious – TDF2 (Truvada heterosexual men & women) – Bangkok Tenofovir Study (injection drug users) – PROUD (Truvada, gay men) – Ipergay (Truvada, gay men) 35
  32. 32. 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 • Important to note – PrEP does work for women, and the FDA prevention indication includes women 36
  33. 33. PrEP works – key findings • Adherence! • 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 37
  34. 34. • Some will experience 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. 38 PrEP works – key findings
  35. 35. PrEP side effects • 1 in 10 will have nausea that subsides quickly. • 1 in 100 will experience bone density loss, which plateaus and doesn’t progress. Not usually clinically significant. • 1 in 200 will experience kidney problems, which resolve after stopping. Can be safe to re-start. 39
  36. 36. 40
  37. 37. I don't have any regrets, but what I do have is peace of mind. And that is exactly what I was looking for with this medication. I feel great, I feel empowered, and I feel in control of my sexual health and my health in general. Personal story on MyPrEPexperience.org 41
  38. 38. 42
  39. 39. 43
  40. 40. 44
  41. 41. 45
  42. 42. 46
  43. 43. • Kaiser Permanente PrEP program in San Francisco • Provides services to over 170,000 adults in SF • Study period: July ‘12 – Feb ’15 • 1,045 referrals for PrEP – 801 at least 1 intake visit – 657 initiated PrEP • 388 person-years PrEP use • Mean duration use 7.2 mos • Increase in referrals and initiation of PrEP noted in Sept 2013 • Mean age 37 (range 20-68) • 653 gay men, 3 hetero cis women, one trans man • Of 657 initiators, 187 dx’d with at least one STI during follow-up, 78 individuals had multiple STIs – After 6 mos use, 30% dx’d with STI (18% rectal) – After 12 mos use, 50% dx’d with STI (33% rectal) 47
  44. 44. • No HIV diagnoses during 388 person-years of f/u • 143 completed survey on behavior change – Number sexual partners • # Unchanged 74% • Decreased 15% • Increased 11% – Condom use • Unchanged 56% • Decreased 41% • Increased 3% – No factors associated with increase in # partners, decrease in condom use • 657 initiators – More likely to report multiple partners – Prior PrEP use (study, other) – Not more likely to have POZ partner • 144 non-initiators – Low risk 35% – Cost concerns 15% – Not wanting to do f/u 10% – Prefer PEP 6.3% – Side effects concerns 2.8% – Concern about potentially increasing risk behavior 1.4% 48Expected incidence: as high as 8.9 per 100 person-years
  45. 45. 49
  46. 46. 50
  47. 47. 51
  48. 48. 52 www.ias2015.org www.aidsmap.com/ias2015
  49. 49. 53 www.ias2015.org www.aidsmap.com/ias2015
  50. 50. 54 www.ias2015.org www.aidsmap.com/ias2015 Dr. Sybil Hosek – CORE
  51. 51. www.aidsmap.com/ias2015 • ATN 110 • 12 U.S. cities, including Chicago • 200 gay (77.8%) and bi (13.7%) men, 18 – 22 (mean 20.18) • 53% Black; 17% Latino; 21% White; 2% Asian/PI; 7% other/mixed • Four HIV infections, not taking PrEP • Adherence good overall, better among those not using condoms • Those who reported most sexual risk were more adherent • Black gay men’s adherence was not as high as others • CALL TO ACTION – need better understanding of historical, societal, behavioral, and attitudinal barriers to PrEP access and adherence among those w/highest impact – young black gay men • Adherence among all groups decreased as study visits moved from monthly to quarterly Dr. Sybil Hosek – CORE55
  52. 52. 56 www.ias2015.org www.aidsmap.com/ias2015 Dr. Al Liu – SF DPH
  53. 53. 57 • PrEP Demo Project • SF, DC and Miami • 557 particps; median age 35 • 48% White; 35% Latino; 7% Black; 10% other • 98% male; 1.3% transgender • Overall high adherence – higher adherence among ppl not using condoms • Two infections, not taking PrEP • Two main findings: “1) we must do active, engaging outreach to African American MSM and trans women about PrEP; we will not reach sufficient numbers through passive attempts to scale- up PrEP, and 2) adherence was lower among African Americans, so additional programs to understand reasons for poorer adherence and to develop support mechanisms are needed for populations most heavily impacted by HIV. Current tools are not enough.” www.aidsmap.com/ias2015 Dr. Al Liu – SF DPH
  54. 54. 58 Chicago PrEP Research
  55. 55. Chicago PrEP research/CORE • Project PrEPare II • Open label demonstration project AND safety study of PrEP in young gay/MSM ages 15-22 – Actively enrolling 300 youth in 13 US sites, Chicago – Evaluating: • Safety of PrEP use among young HIV-neg gay/MSM • Acceptability, patterns of use, and adherence • Risk patterns • Texting to encourage adherence • Demographic and/or behavioral differences among youth –Interested in a PrEP study –Who stays on PrEP 59
  56. 56. Chicago PrEP research/CORE • Enhancing PrEP in Communities (EPIC) • To test the effectiveness of Prepmate, a novel multi- modal, technology-based intervention for pre-exposure prophylaxis (PrEP) adherence support among young gay men/MSM. – Uses SMS support and interactive online content to enhance PrEP adherence • The control condition includes standard of care support for gay/MSM who are starting PrEP. – Brief health educator-provided adherence and risk reduction counseling at scheduled study visits, and access to a clinician whenever needed. 60
  57. 57. 61
  58. 58. 62 PrEP is more than a prescription PrEP is a program
  59. 59.  Take Truvada every day  Provider* visits every 3 mos  HIV testing every 3 mos  Tied to Rx renewal  Hepatitis B testing  Kidney function testing  Regular STI screening  Pregnancy testing 64 *These activities don’t all need to be done by a doctor in their office Taking PrEP… What does it take?
  60. 60.  Adherence counselling  Perfection not required, especially for rectal exposure  Take 5 – 7 days before enough drug is “on board” to provide protection in the rectum, 3 weeks for the vagina  Then take Truvada every day  Honest, open discussions about sex, sexual health  PreP is “seasonal.”  PrEP is not forever. 65 Taking PrEP… What does it take?
  61. 61. 66
  62. 62. • iPrEX Open Label • 1,603 participants, 1,225 on PrEP • Most from Peru/Ecuador, 18% USA • 100% effectiveness associated with 4+ doses a week (rectal) • 84% effectiveness in ppl who took 2 -3 doses a week • Ppl engaging in higher risk sex self-selected for PrEP • Adherence issues more pronounced among young people 67
  63. 63. What PrEP does not do • Truvada as PrEP does not – Guarantee 100% protection from HIV (what does?) – Protect a person against other STIs like chlamydia, syphilis, or gonorrhoea – Prevent pregnancy – Cure HIV – Function as a treatment regimen for someone already living with HIV. 68
  64. 64. 69
  65. 65. 70 • True or False: PrEP does not work for women. • True or False: About 25% of people who take PrEP will have nausea. • True or False: Regular STD screening is not necessary while being on the PrEP program. • True or False: You don’t need to adhere perfectly to PrEP to achieve high levels of protection. • True or False: Obama endorses PrEP.
  66. 66. 71
  67. 67. tinyurl.com/ChicagoPrEPforum 72
  68. 68. www.myprepexperience.org
  69. 69. Who might be a good fit for PrEP? •Person indicates an interest in taking PrEP 75
  70. 70. Who might be a good fit for PrEP? • Person is in a “magnetic” relationship –HIV-negative and has HIV+ partner who is not on meds, or not undetectable, or other mitigating circumstances 76
  71. 71. Who might be a good fit for PrEP? • Male, female, transgender person engaging in 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 – Injects drugs one or more times daily – Shares injection equipment – Injects cocaine or meth 77
  72. 72. PrEP-C
  73. 73. pleasure intimacy connection emotion lust love
  74. 74. 80 In this sample of men who are in a relationship with a perceived HIV-negative man, we found that intimacy motivation was the strongest predictor of adopting PrEP. “Intimacy Motivations and Pre-exposure Prophylaxis (PrEP) Adoption Intentions Among HIV-Negative Men Who Have Sex with Men (MSM) in Romantic Relationships” – Annals of Behavioral Medicine August 2014
  75. 75. 81 Reclaim pleasure
  76. 76. 82
  77. 77. 84
  78. 78. Accessing PrEP in Chicago • Any medical provider who can write a scrip can write one for Truvada as PrEP • tinyurl.com/ChicagoPrEPproviders 85
  79. 79. 86 PrEP at CORE
  80. 80. PrEP Access –The CORE program 87 • HEAT – Helping Eliminate AIDS through Teamwork • Health Educators are first line for PrEP Clinic – PrEP education, screenings, initial lab tests, benefits – Health educator appointments available Monday – Thursday
  81. 81. PrEP Access –The CORE program 88 • Primary clinic location: CORE Center – Monday afternoons for youth under 25 – Tuesday evenings and Friday afternoons for all • Secondary locations: Fantus Adolescent Clinic, Wednesday/Thursday afternoons • Project Coordinator: Raymond McPherson (312/846-3578)
  82. 82. PrEP Access –The CORE program 89 • Initial screening appointment in PrEP clinic will include Rx if necessary lab tests are in medical record (HIV, CrCl) • 1 month f/u appointment for adherence, side effects • 3 month f/u, then quarterly • Adherence, risk reduction support provided in clinic by HE, HEAT staff • Access to research opportunities
  83. 83. 91
  84. 84. Uninformed, misinformed providers 92
  85. 85. 93
  86. 86. Handy brochure 94 Designed to help individuals talk to their doctors about PrEP Before, during, after visit Questions to ask Web resources tinyurl.com/talkPrEPtoDr
  87. 87. 95 PrEPline, 855-448-7737 The CCC Pre-Exposure Prophylaxis Service 11 a.m. – 6 p.m. EST http://nccc.ucsf.edu/2014/09/29/introducing-the-ccc-prepline/ PrEP Warm Line
  88. 88. • MyPrEPexperience.org • Chicago PrEP Line - (872) 215-1905 hivelimination.uchicago.edu/projects/programs/prep_hotline_linkage_to_care • Chicago PrEP provider listing tinyurl.com/ChicagoPrEPproviders • Facebook group – PrEP Facts • Facebook.com/ProjectRSP • PrEPWatch.org • ProjectInform.org/prep • Truvada.com (Gilead) • WhatisPrEP.org (video) Web resources on PrEP 96
  89. 89. www.facebook.com/groups/PrEPFacts 97
  90. 90. 98 PositivelyAware.com Printed copies available email distribution@tpan.com
  91. 91. 99
  92. 92. 100 Please like, follow us on Facebook facebook.com/ProjectRSP
  93. 93. FDA approval of Truvada enables private ins to cover Medicaid formulary Ins companies covering, so far ADAP does not cover PrEP 102
  94. 94.  Drug costs  Visit, service costs  Lab costs 103
  95. 95. 104 the devil is in the details  Premiums  Deductibles  Cost-sharing  Drug formularies  Drug tiers  Shifting benefits  Not easy to figure all this out!
  96. 96. 105 http://ow.ly/PTYCK
  97. 97. Paying for PrEP – Gilead 1. Visit www.truvada.com 2. Click on the link to access information about Truvada for a PrEP indication 106
  98. 98. Medication Assistance Program • Gilead will provide Truvada for PrEP at no cost for individuals who qualify for the assistance program Program Element Truvada PrEP Medication Assistance Program Eligibility Criteria US resident, uninsured or no drug coverage, HIV- negative, low income (500% FPL) Drug Fulfillment Product dispensed by Covance Specialty Pharmacy, labeled for individual patient use and shipped to prescriber (30 day supply); no card or voucher option Recertification Period 6 months, with 90 day status check 107107
  99. 99. Co-pay card program Covers all Gilead HIV Products: Stribild, Complera, Atripla, Truvada, Viread, Emtriva • Assists patients with commercial insurance who reside in the US, or US Territories • Not valid for Rx that are eligible to be reimbursed by any federal or state funded healthcare benefit program • Co-pay benefit provides assistance for co-pays above $0 • Monthly benefit provided for 12 mos after activation of card – $400/month for all STRs (Stribild, Complera, Atripla) – $300/month for (Truvada, Viread, Emtriva) • No maximum lifetime benefit but pts need to recertify after 12 months 108
  100. 100. 109 • www.panfoundation.org/hiv-treatment-and-prevention • Accepting applications for new and renewal patients. If application for assistance is approved can begin receiving funding immediately • Maximum Award Level – $4,000 per year. • Patients may apply for second grant during eligibility period subject to funding availability Paying for PrEP – PAN Foundation
  101. 101. 110
  102. 102. 111 USCA 2014
  103. 103. 112
  104. 104. 113 www.ias2015.org [Quote from female sex worker participating in treatment and PrEP demo project in Johannesburg, South Africa.]
  105. 105. 114
  106. 106. 115 • How can people pay for their PrEP prescriptions? • People taking PrEP need to be tested for HIV _____ times every year. • Why is this important? • Who might be a good fit for PrEP?
  107. 107. 117
  108. 108. 118 “Party drug” “Public health disaster”
  109. 109. 119PrEP DENIALISM
  110. 110. 120
  111. 111. 121 Condom privilege
  112. 112. 122 “But ARVs are toxic…”
  113. 113. 123
  114. 114. Tips for talking about PrEP • You need not be an expert. • Though, it’s important you feel comfortable talking about PrEP. • It’s okay to not have all of the answers. Refer your client to additional resources and/or promise to follow up. 125
  115. 115. Tips for talking about PrEP • As a provider, you are viewed as a trusted source of information. • Remember any perspectives/opinions you have about PrEP and/or people who use PrEP will translate to your clients. 126
  116. 116. Messages to emphasize to clients • PrEP is an accessible option – Not forever, but maybe for a “season” – If you use condoms successfully, do you need PrEP? • It’s not just a daily pill, it’s a program. – Holistic health care (w/regular HIV and STD testing) • Person must test HIV-negative to initiate and continue PrEP. • Adherence. Different for men and women. 127
  117. 117. THOUGHTFUL RESPONSIBLE CAREFUL 128 AWARE PRO-ACTIVE DISCIPLINED TAKING PREP IS
  118. 118. SAFER SEX TAKING PREP IS 129
  119. 119. PrEP elevator speech • You get in the elevator at the 95th floor with someone who has just asked you about PrEP. You have until ground level to explain it to them. »What do you say? • Take a few moments to think • Volunteers to share? 130
  120. 120. 131
  121. 121. 132 "Interventions do not just work automatically, they have to be made to work – and people have responsibility for making them work. And herein lies the rub – for the question we should ask is not “what works?” but “what are we committed to making work?” – Dr. Flora Cornish London School of Economics
  122. 122. tinyurl.com/ChicagoPrEPforum 133
  123. 123. 134 Open access http://www.jiasociety.org/index.php/jias/issue/view/1474
  124. 124. 135
  125. 125. 136
  126. 126. Thank you!! 137
  127. 127. 138
  128. 128. 139
  129. 129. CONTACT Jim Pickett jpickett@aidschicago.org Sybil Hosek sybilhosek@gmail.com 140 #yayPrEP Download these slides: tinyurl.com/PrEPSept1115

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