This blog is based on the “Persistence in a pharmacist-led, same-day PrEP program in Mississippi: a mixed-methods study” published by BMC public health.
This study utilized data from individuals referred to a same-day PrEP initiation program (“Rapid PrEP”) at Express Personal Health (EPH), a University of Mississippi Medical Center-affiliated, walk-in HIV/STI testing-only clinic in Jackson, Mississippi.
PrEP as prevention is key
Let’s face it: engaging in preventative activities (i.e., taking PrEP or using condoms) is not always top-of-mind when you’re about to top (or bottom).
In fact, only one-third of men in the U.S. say they use condoms and only 25% of people who could be on PrEP are on PrEP.
But prevention remains one of the most essential elements to reduce new HIV infections by 90% by 2030, which is a Centers for Disease Control and Prevention (CDC) public health goal.
Oral HIV PrEP (pre-exposure prophylaxis) can help reduce the risk of getting HIV by 99% if taken as prescribed (once daily).
So how can we work together as a community to encourage prevention?
Q Care Plus is here to answer questions on all things sexual wellness: read to learn more!
Barriers like cost and insurance persist, but Q Care Plus can help you get on PrEP
It’s no secret that insurance status and cost can prevent people from getting PrEP. This has been an issue since the Food and Drug Administration (FDA) first approved PrEP 11 years ago.
Enter Q Care Plus, a solution to some of these issues.
Unfortunately, barriers experienced at the pharmacy dissuaded participants in this study from starting PrEP. Oftentimes, providers and pharmacists don’t have the resources or knowledge to navigate insurance issues, which might lead to people being denied their medication.
At Q Care Plus, we work with pharmacy partners like Avita Pharmacy where the team is educated on all things HIV prevention and care. Many big-box retail pharmacies do not have specialists who are familiar with HIV prevention and care.
But our partner pharmacies ensure that, once patients are prescribed PrEP, they will not be turned away or experience additional barriers.
We asked Q Care Plus Clinician Lead Dr. Jennifer Belfry, DNP, FNP-BC, AAHIVS, to help answer some pressing questions about barriers.
“There are federal recommendations that state that PrEP should have no out-of-pocket cost for the patient. But we know in practice, that’s not always what happens,” said Jennifer.
“So here at Q Care Plus, our services include the cost of labs and the cost of the visit. There is no co-pay for either of these. We work with pharmacies to eliminate co-pays as much as possible.
That just leaves the cost for the medication itself, which we have plenty of programs that patients can apply for, and we help navigate patients through. We want to keep that cost as close to zero as possible.”
What if I don’t have insurance?
For those without insurance, there are still options.
“It depends on which state the patient is in, but for uninsured patients, we help them apply for things like the Gilead Assistance Programs, or Ready Set PrEP to get them medication for free,” said Jennifer.
Is “Perceived Risk” the best motivator to get on PrEP?
Perceived risk is a person’s subjective evaluation of their risk of an illness or an adverse outcome, according to Springer.
One might say that “perceived risk” is like fear. Is fear the best motivator?
Jennifer said, “Perceived risk is truly flawed because we know that most people who could use PrEP and could benefit from protection are not actually accessing it, and it’s probably because their perceived risk is low. They don’t think they’re at risk for HIV infection, and thus they don’t seek out the service. Fear is also not the greatest motivator because it tends to be stigmatizing.”
What are the reasons you should be on PrEP, then?
“We want people to feel empowered and to feel healthy and to make healthy choices. So, it’s more of a positive self-care, positive self-outlook, reason for taking PrEP and not fear motivated,” Jennifer said. “Take it to take care of yourself and your partners.”
What are some myths about PrEP?
Another reason that people might not take or stop taking PrEP is because of misinformation about the drug.
- PrEP is a “morning after pill.” This is false, PrEP is taken daily before exposure to prevent HIV. PEP (post-exposure prophylaxis), on the other hand, can be taken after exposure to prevent HIV.
- PrEP is not prescribed but something you can get over the counter. This is partially false. Several U.S. states—including Illinois, Michigan, Minnesota, Montana, Nebraska, New Mexico, North Dakota, South Dakota, Tennessee, Vermont, Washington, and Wisconsin—have given pharmacists the authority to prescribe PrEP themselves over the counter. However, other states still require people to meet with clinicians before they can access the medication.
- PrEP is only for people who have sex with multiple partners. This is false. Even if you only have sex with one person, it’s still a good idea to take PrEP, especially if your partner is engaging in sex with others. Also, various kinds of relationship structures exist, like solo polyamory, non-monogamy, and more. So, PrEP is still an essential part of a healthy sex life.
- PrEP is only for men. This is false. Oral PrEP is also safe and effective for women and people assigned female at birth. It is also safe to take during pregnancy with extra monitoring by your provider.
When asked what other common misconceptions exist among patients, Jennifer said, “I think some of the important misconceptions are just not believing that you need it. Thinking you’re not at risk of HIV, and that’s the main reason people don’t get on PrEP or take PrEP, is because they don’t think it’s for them. They think ‘I’m a straight male, I only have female partners’ or ‘I’m a female with only one or two male partners.’ But if you’re not entirely certain about your partner’s HIV status, then it would be safest to be on PrEP.”
About a quarter of all new HIV infections in the U.S., every year occur after heterosexual sex.
HIV testing isn’t always a guarantee
HIV testing also has a waiting period, so it’s important to protect yourself regardless of your partners’ test status.
“With HIV testing, there’s always a testing window. You could test negative today, but that negative test does not mean you don’t have HIV today. It means three weeks ago you didn’t have HIV. There’s always a three-week delay for most HIV tests, meaning your test will not turn positive until 3 weeks after you have been infected. So, you can’t always be certain of someone’s status just based on testing. If they’re taking PrEP and you’re taking it, the risk of you giving each other HIV goes to zero. So why not be safe?”
What are the side effects and how long do they last?
Another reason why patients might not get on or stay on PrEP is side effects.
There are definitive differences in side effects for the two primary brands of oral PrEP, Truvada® and Descovy®. Nausea is the most common symptom and can happen when taking either brand of oral PrEP.
Jennifer said, “I usually tell patients it’s not vomiting necessarily, but we call it GI upset or acid reflux, or the feeling of a sour stomach. [To relieve it] you can take the medication with food or if you take it at bedtime, there’s a chance you’ll sleep through that symptom, and you won’t feel anything. And usually that GI upset resolves in the first seven to 10 days of taking PrEP.”
One thing many patients are afraid of and another common misconception floating around about PrEP is that it causes long-term side effects like kidney damage. People taking Truvada® are at risk for this symptom.
However, “[Kidney damage is] rare and it depends on which medication you are taking for PrEP. It’s not expected to happen to everybody who’s taking PrEP, and would occur after years of taking oral PrEP,” said Jennifer.
“Newer medications for PrEP come with fewer side effects for the kidneys and work just as well at protecting you from HIV.”
Link to ongoing care
Over 59% of the people in the study referenced did not link to ongoing care after being prescribed PrEP, which is one of the main reasons they dropped out of care.
How can you avoid that?
With Q Care Plus, you have access to ongoing care at the tip of your fingers through online appointments with our providers. Sign up today to get started and to stay in long-term preventative care that’s for everyone!
Dr. Jennifer Belfry, DNP, FNP-BC, AAHIVS, has her Masters in Science as Nurse Practitioner from Columbia University and a Doctorate of Science in Nursing Practice from the University of Massachusetts where her doctoral project was “Introduction of HIV Point-of-Care Testing in Adolescent Primary Care.” Dr. Belfry is also a certified HIV Specialist and has over a decade of nursing experience in a variety of practices, including family medicine, and she currently serves as the Clinician Lead at Q Care Plus.