Transcript Are you PrEPed?: Exploring New HIV Prevention Tools Presented by: Monica Ramirez and Joaquin Gutierrez.

Are you PrEPed?:
Exploring New HIV Prevention Tools
Presented by: Monica Ramirez and Joaquin Gutierrez
PrEP
Objectives
• AltaMed Health Services
• Discuss HIV Prevention Methods – Then, Now, &
Future
• What is PrEP? What is PEP? Is there a Difference?
• Speaking to clients about PrEP and PEP
• Discuss access to PrEP and PEP
2
AltaMed Health Services
Mission: To eliminate disparities in health care
access and outcomes by providing superior
quality health and human services through an
integrated world-class delivery system for
Latino, multi-ethnic and underserved
communities in Southern California.
3
AltaMed Programs & Services
•
•
•
•
•
•
•
•
•
Primary Care
Women's Health and Children's Specialty Senior Services
Dental Services
HIV Testing and HIV Medical Care
Health Education
Chronic Care Support
Youth Programs
Drug Treatment / Prevention
Pharmacy
4
AltaMed’s Physical Locations
HIV Specialty Clinic & Storefront Testing Location
• 2 sites located in East Los Angeles, 1 in Orange County
• 2 satellite clinics in Pico Rivera and El Monte
5
PrEP
HIV Prevention Tool Box
6
PrEP
What is PrEP?
7
PrEP
What is PrEP?
PrEP = Pre-Exposure Prophylaxis
• Approved in 2012 for Prevention
• Involves taking anti-retroviral medications daily to
reduce risk of infection BEFORE HIV exposure
• PrEP prevents HIV from replicating in the body
• Truvada® as PrEP
• One pill
• Once daily
• Every day
8
PrEP
Initial Medical Visit
•
•
•
•
•
•
Health Physical
HIV test
STI exam
Blood draw for Kidney and Liver function
Risk behaviors
Prescription is given
9
PrEP
FOLLOW-UP VISITS
•
•
•
•
•
•
Medical Visits every 3 months
HIV test
STI test
Blood draw to see how body is reacting to Truvada
Counseling on sexual behaviors
Treatment Adherence
10
PrEP
Medical Visits
Side effects
• Upset stomach
• Loss of appetite
• Mild Headaches
Usually only reported in the first month of taking PrEP
11
PrEP
What does PrEP not do?
• Protect against other STD’s
• Prevent pregnancy
• Function as treatment for someone living with HIV
already
• Cure HIV
• Like most prevention methods, does not offer100%
protection from HIV infection
12
PrEP
PrEP RESEARCH
•
PrEP only works if taken
•
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 so far
13
PrEP
How do you access PrEP?
• Any MD, DO, PA, or NP can prescribe Truvada
• PrEP is covered by most third-party insurance plans and
also covered through Medi-Cal
• Clinic-based studies being done in Los Angeles County
provide Truvada at no cost
• Gilead patient assistance program: www.truvada.com
• Drug Provision
• Co-Payment Assistance
• Lab cost reimbursement (HIV & HBV)
14
PrEP
MOTIVATIONAL INTERVIEWING
•
•
•
•
•
Non-judgmental
Identifying and discuss discrepancies
Roll with resistance
Promote Self-Efficacy
Implementing a Treatment Adherence Plan
15
PrEP
Who benefit from PrEP?
• Discordant couples
• Clients who have used PEP
• People who can’t use condoms
• Individuals who don’t want to use condoms
• IDU- intravenous drug users
• People who think they could benefit
16
PEP
WHAT IS PEP?
17
PEP
WHAT IS PEP?
•
•
•
Post-Exposure Prophylaxis
Prophylaxis is any way to prevent,
rather than treat or cure a disease
•
•
•
•
In current approved form, PEP is
either a combo of 2 or 3 antiretroviral drugs
• 2 drug regimen – Truvada
(tenofovir + emtricitabine)
• 3 drug regimen – Truvada and
Isentress (raltegravir)
Used as HIV prevention within 72
hours of potential exposure
Medication must be taken for 28
days after potential exposure
PEP users must get HIV testing at 4
to 6 weeks, 3 months, and 6 months
after the potential exposure
Source: CDC, PEP 101
18
PEP
HOW DO WE KNOW PEP WORKS?
• PEP originally approved in
1996 for health care workers
exposed to HIV through job
• PEP reduced the rate of HIV
infection from workplace
exposures by 79%.*
• In 2005, CDC approved PEP
for non-work HIV exposure.
• Specific drugs used in PEP
have changed as more
effective medications become
available.
Source: AIDS.org
•
Other sources of data on PEP
efficacy:
• From animal transmission
models
• Perinatal clinical trials
• Studies of health-care
workers receiving
ARVs after occupational
exposures
• Observational studies
19
PrEP
SIDE EFFECTS OF PEP
• PEP can cause diarrhea, headaches, nausea and vomiting.
• These side effects stop once you have finished taking the
drugs or after first week of taking PEP.
• One Australian study revealed that 2 out of 3 people taking
PEP experienced mild to moderate side effects and 1 in 4
people taking PEP experienced severe side effects.
20
PEP
HOW DO CLIENTS ACCESS PEP?
Emergency Rooms
• Any Emergency Room can provide PEP
• However, ERs usually only provide 3 days of medication
(a“starter pack”)
Primary Care Providers
• Any doctor can prescribe
• Accessing in 72 hour window can be a challenge
• Staying engaged for testing period also can be difficult (HIV test
at 4-6 wks, 3 mos, 6 mos required)
HIV Agencies
• OASIS Clinic (Free)
• LA LGBT Center (Free)
21
PrEP
ACCESSING PEP IN LOS ANGELES COUNTY
• Los Angeles LGBT Center
– Jeffrey Goodman Clinic
– 1625 N. Schrader Blvd. Los Angeles 90028
– Phone: 323-860-5855
– [email protected]
– http://www.lalgbtcenter.org/post_exposure_pro
phylaxis_pep
22
PEP
MEDICAL VISIT
• Risk Assessment
• HIV Test
• Provided Prescription
• Follow-Up appointment with Provider
23
PrEP
HOW MUCH DOES PEP COST?
• Can cost $1,000 + for the 28-day
treatment
• Insurance can cover
• Medicaid coverage inconsistent
• Pharmaceutical corporation access
programs can help
• State Office for Victims of Crime can
pay for sexual assault survivors
• CalVCP Helpline: 1-800-777-9229
24
PEP
PATIENT ASSISTANCE PROGRAMS for PEP
25
PEP
PATIENT ASSISTANCE PROGRAMS FOR PEP
26
PEP
PATIENT ASSISTANCE PROGRAMS FOR PEP
27
PEP
TOOLS FOR PEP EDUCATION
TALK PEP Campaign
• Social marketing campaign by
Fenway Health to increase
knowledge of PEP among gay
and bisexual men in Boston.
• Common reasons for potential
exposure to HIV, used to catch
audience attention
• Graphics & videos accessible
free of charge
http://talkpep.org/
28
PEP
TOOLS FOR PEP EDUCATION
•
Centers for Disease Control & Prevention
– PEP 101
http://www.cdc.gov/hiv/basics/pep.html
– PEP for Non-Work Exposure Guidelines (2005)
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm
– PEP for Work Exposure Guidelines (2005)
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm
•
•
http://publichealth.lacounty.gov/dhsp/PEP-Provider.htm
http://www.avert.org/post-exposure-prophylaxis-pep.htm
•
AIDS.gov
– POST-EXPOSURE PROPHYLAXIS
http://aids.gov/hiv-aids-basics/prevention/reduce-your-risk/post-exposureprophylaxis/
29
PrEP and PEP
TREATMENT ADHERENCE TIPS
How can I remember to take my medication?
• Take your medications at the same time you brush your teeth morning
and night - and place the medications near your toothbrush so you will
notice them.
• Set the alarm on your mobile phone to remind you to take your
medications
• Get someone you trust to remind you to take your medications
30
HIV PREVENTION TOOLS
Condoms
PrEP
PEP
31
Contact Information
THANK YOU
Monica Ramirez
HIV Prevention Supervisor
323-307-0137
[email protected]
Joaquin Gutierrez
HIV Prevention Specialist
323-307-0131
[email protected]
32