More than 1 million people in the United States are at risk for HIV. That's more than a million chances to prevent the disease with the use of pre-exposure prophylaxis (PrEP). But only a small fraction of those patients actually receive PrEP medications. As dismal as that reality is, the COVID-19 pandemic has made it even worse because now, accessing care at the places where PrEP is prescribed is harder to do.
Here are five things to know about PrEP during the COVID-19 pandemic.
1. When taken as prescribed, PrEP is safe and highly effective in preventing HIV.
The most important thing to know about PrEP hasn't changed. Bottom line: PrEP works. It reduces the risk of getting HIV from sex by about 99% when taken as prescribed. Among people who inject drugs, PrEP can reduce the risk of getting HIV by at least 74%. The US Preventive Services Task Force has given PrEP a grade A recommendation, meaning that there is high certainty that PrEP's net benefit is substantial.
For more information about PrEP and when to prescribe it, access the Centers for Disease Control and Prevention's (CDC's) provider brochure, Prescribe PrEP: Pre-exposure Prophylaxis — FAQs.
2. Two medications are approved for daily use as PrEP.
Emtricitabine (F) 200 mg in combination with tenofovir disoproxil fumarate (TDF) 300 mg (F-TDF; brand name Truvada) is recommended for all people at risk for HIV through sex or injection drug use.
Emtricitabine (F) 200 mg in combination with tenofovir alafenamide (TAF) 25 mg (F-TAF; brand name Descovy) is recommended for people at risk through sex, excluding people at risk through receptive vaginal sex. Descovy has not yet been studied for HIV prevention for receptive vaginal sex, so it may not be appropriate for some people.
3. PrEP has not been observed to cause serious side effects.
PrEP can cause side effects, such as nausea, in some people, but these generally subside over time and are not life-threatening. No serious side effects have been observed. In people without HIV who have taken PrEP for up to 5 years, no significant adverse health effects have been recorded.
4. CDC has issued guidance to help ensure continued access to essential PrEP services during COVID-19.
Given the unprecedented challenges stemming from the pandemic, CDC has issued guidance to help ensure continued access to essential PrEP services:
Consider providing a prescription for a 90-day supply of PrEP medication for your patients to minimize trips to the pharmacy and to facilitate PrEP adherence.
Continue quarterly HIV testing for patients taking PrEP, with lab-only visits. If lab visits are not available, consider:
Home specimen collection kits for HIV and sexually transmitted infection tests and
If you must suspend services in your own practice, establish referral relationships with other clinics, telemedicine services, or pharmacies so that your patients may remain engaged in PrEP care.
Continue to follow the recommendations outlined in the 2017 PrEP clinical practice guideline and its associated clinical providers' supplement.
To learn more about providing PrEP services, visit CDC's HIV Nexus website. Information is updated when available.
5. Ready, Set, PrEP can help people without health insurance access PrEP.
On December 3, 2019, the US Department of Health and Human Services launched Ready, Set, PrEP, a national program that makes medications for PrEP available at no cost to people without prescription drug insurance coverage.
To qualify for Ready, Set, PrEP, people must test negative for HIV, have a valid prescription for the medication, and not have prescription drug coverage. All medications are fully covered for qualifying participants; however, the costs of necessary clinic visits and lab tests may vary depending on an individual's income.
People can find out if they qualify by visiting GetYourPrEP.com or calling toll-free 855-447-8410.
Healthcare professionals looking to enroll a patient in the program can click here.
Jonathan H. Merman is the director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) at the CDC and a Rear Admiral in the US Public Health Service.
Follow the CDC on Twitter
Follow Medscape on Facebook, Twitter, Instagram, and YouTube
Public Information from the CDC and Medscape
Cite this: PrEP During COVID-19: 5 Things to Know - Medscape - Sep 16, 2020.
