What is PrEP and who should take it?
“Pre-exposure prophylaxis, or PrEP, is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill every day. The pill (brand name Truvada) contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV. When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection.
When taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92%. PrEP is much less effective if it is not taken consistently” (CDC 2017).
Persons at high risk for HIV transmission include: persons who are having multiple sex partners, persons who do not consistently use condoms, males who have sex with other males, transgendered persons (especially MTF), persons engaging in sex work, people who inject drugs, and serodiscordant couples (one person is HIV positive and one person is negative). PrEP should be considered for persons who have been diagnosed with another sexually transmitted infection within the last year.
How do you get on PrEP?
APW has a partnership with UMASS memorial to provide PrEP to indicated persons. Those coming into the Joe McKee Care Center who are interested in PrEP should be tested. An HIV test is mandatory but the full panel is strongly recommended. The client must sign a release of information between APW and UMASS as this allows us to send over contact information, case notes, and test results. The client must have insurance and agree to be seen at UMASS once every three months for follow up testing. Clients will need to be prepared to take a pill every day and have a place to store medication.
Pre-PrEP Testing and ongoing labs
Before getting on PrEP clients will need to be tested for HIV, Hepatitis B, and have a creatinine test to check kidney function. The HIV and creatinine test will need to be completed every 3 months for ongoing PrEP patients. This is because if a person were to seroconvert (become positive) Truvada alone is not sufficient to treat HIV and they would need an additional medication. If that is not caught early the virus could become resistant to tenofovir and emtricitabine which are two very common HIV medications. Kidney function is watched closely because Truvada uses an older formulation of tenofovir which is better for prevention but can be a bit more harsh on the kidneys. Complications are rare but creatinine is monitored closely as a precaution and in the event that any negative impacts were noted on the kidneys the medication would be stopped quickly.
How do you pay for PrEP?
Clients interested in PrEP should have insurance or qualify for MassHealth. Different insurances have varying copays depending on coverage and clients should reach out to their insurances to inquire what the copay would be. Medication copay assistance is currently available through the PrEP Drug Assistance Program * and the Gilead Access Program. Referrals for these programs can be completed through Pat or Fernanda at UMASS. These programs do not currently cover lab copayments. There are a few insurances that are not accepted by UMASS including BMC and Fallon. If the client has Fallon or BMC through MassHealth they may be able to change their plans. For all insurance questions refer to Fernanda and when in doubt complete the referral and UMASS can help guide the patient through that process.
* The Massachusetts Pre-Exposure Prophylaxis Drug Assistance Program (PrEPDAP) helps Massachusetts residents pay for approved medications that can prevent the transmission of HIV. The program assists clients in need by covering out-of-pocket costs for Truvada (tenofovir/emtricitabine), including copays, co-insurance, and up-to-full-cost payments towards a deductible. PrEPDAP can also cover the full cost of Truvada, if necessary, for individuals who lack health insurance. Truvada is a medication which has been shown to significantly reduce the likelihood of transmission of HIV between individuals and is the only FDA-approved medication for use as PrEP.
PrEPDAP is a program of the Office of HIV/AIDS in the Bureau of Infectious Diseases at the Massachusetts Department of Public Health and is administered by Community Research Initiative (CRI). https://crine.org/hdap/prep-drug-assistance-program/
Contact:
Amanda Mehaffey
Coordinator of Prevention and Screening