We're prescribing the end of HIV

Providers in Santa Clara County are playing a vital role in ending the HIV epidemic. PrEP, a medication that’s highly effective in preventing HIV transmission, can be prescribed by any provider. Most providers will have patients who can benefit from this intervention. Please join us in this important effort.

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What is PrEP?

Pre-Exposure Prophylaxis (PrEP) is an HIV prevention medication for HIV-negative people who may be at increased risk for becoming infected.

Truvada, the only drug approved by the FDA for use as PrEP as of June 2019, is a single pill that combines two anti-HIV drugs – tenofovir and emtricitabine. When taken consistently, as prescribed by a health care provider, Truvada reduces the risk of HIV infection for those at risk.

Why prescribe PrEP?

The CDC has established that daily intake of Truvada for PrEP lowers a patient’s HIV risk through sex by over 90% (while other sources have quoted efficacy rates as high as 92-99%) and through shared drug injection equipment by more than 70%.

What steps are essential to offering PrEP to your patient?
  • Taking a medical and social history
  • Obtaining baseline testing
  • Assessing and referring to payment options for PrEP
Which criteria can help determine if your patient is a good candidate for PrEP?
  • Having a sexual partner who lives with HIV
  • Not knowing the HIV-status of their sexual partner(s)
  • Having an STI, especially gonorrhea, syphilis, or any rectal infection
  • Being a man with male sexual partners
  • Belonging to the transgender or gender non-binary communities
  • Engaging in sex work
  • Using recreational drugs or large amounts of alcohol
  • Recently threatened with violence or physically harmed by their partner(s)
  • Being in a serodiscordant relationship where one partner is trying to get pregnant
  • Asking for PrEP or for additional options for HIV prevention
What groups have been included in PrEP clinical trials to date?
  • Gay and bisexual men
  • Transgender women and gender non-binary individuals (TGNB)
  • Heterosexual women
  • Serodiscordant couples
  • People who inject drugs
Are you comfortable having a conversation with your patients about sexual health?

If you feel some level of discomfort and anticipate your patients feeling the same, there are several training options for you, including sexual health guides or leadership courses.

Do you feel well-prepared to have sexual health discussions with your patients who belong to the LGBTQIA community?

Navigating these discussions in a non-judgmental and culturally sensitive way, particularly with members of marginalized groups like the LGBTQIA community, is integral to the provider-patient relationship and uncovering the information needed to determine PrEP eligibility.

Is there a minimum age for eligible PrEP patients?

No. The approval of PrEP as an HIV prevention option has been expanded to include people at risk for HIV of any age who weigh at least 77 pounds.

Would it be beneficial to have conversations with your senior patients about PrEP?

Yes! A common myth is that people of a mature age do not have sexual relations. Reports have revealed that 50% of people in the United States living with HIV are over the age of 50 and 17% of new HIV infections occur in people over 50.

What can you say to patients with concerns around not being able to afford PrEP?

MediCal, Covered California, and most other third party payors cover the full cost of PrEP medication. Additional resources exist for helping patients cover copayments and costs related to PrEP care.

The Gilead Advancing Access program offers information to help your patients find co-pay support, government insurance support, and uninsured support – regardless of their citizenship status. These programs include access to counselors who can help patients and their providers figure out coverage options and other insurance-related topics.

Are you interested in prescribing PrEP?

If so, please take a look at prescription details put together by the official Truvada for PrEP site.

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The Santa Clara County Public Health Department has prepared a toolkit outlining clinical guidelines as they relate to PrEP, screening patients, and administrative procedures.

For expert clinical consultation on PrEP, email prep@sfdph.org.

This California-based page offers support for becoming a more “PrEP-friendly” provider, as well as inclusive, sex-positive PrEP details and tools for your patients’ use and yours.

This handy read from HIVE (UCSF) addresses HIV stigma by suggesting preferred language around HIV.

The World Health Organization (WHO) has developed an app to assist clinicians, testingproviders, pharmacists, and counsellors in their efforts to prescribe PrEP and monitor patients.