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.

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?