Ready, Set, PrEP: We are not ready or set.

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When I heard a couple days ago about the new Ready, Set, PrEP (RSP) initiative from HHS, something did not sit right with me and I couldn't quite put my finger on it. After having some time to digest the program materials/publicity and do some more work on my own PrEP program, the uneasiness is coming a bit more into focus.

RSP is essentially the US government's way of distributing the 2.4 million bottles of Truvada for PrEP that were donated by Gilead Sciences, Truvada's pharmaceutical manufacturer, to 200,000 uninsured Americans. Gilead currently offers the same exact service through its Advancing Access Program (AAP); in fact, RSP uses the same exact platform that is used by Gilead (iAssist), meaning that my clients who were previously enrolled in the AAP iAssist system already exist in the RSP program system. Ultimately, there are no new people who will benefit from this program that would have not benefitted from Gilead's program - the only difference is that the program is now government-run.

My health department's STI/FP clinic has capacity to see about 60 patients per week. Currently, there are 24 clients enrolled in our PrEP program who have to come to the clinic every 1, 2, or 3 months depending on how long they have been on the medication. There are over 3,500 estimated people in our county who meet CDC clinical indications for PrEP (history of a bacterial STI, multiple partners, inconsistent condom use, HIV+ partner with detectable viral load, or IV drug use with shared works). Though there are two other practices in my county that prescribe PrEP (according to PrEPlocator.org), three practices aren't enough to provide services to all of the people in the county who need PrEP. Thus, the health department is working on a provider outreach campaign to get more people up to speed on PrEP clinical practice guidelines and other practices that promote sexual health, including:

As I read through literature on PrEP-related clinician knowledge, attitude, and practice assessments from 2012 to present, I am struck by how little growth there has been in these areas. The vast majority of surveyed clinicians don't take sex histories, aren't familiar with CDC guidelines on PrEP prescription, and aren't particularly interested in getting involved with prescribing or referring for PrEP. I accept that as reality and am working to shift that reality. However, the RSP initiative endeavors to bolster demand without addressing the issue of provider readiness. Folks who have a new or renewed interest in PrEP will report to providers and be told, as I have heard many times before, that the provider either does not know what that is or does not offer that service. With CVS MinuteClinics now offering PrEP as part of RSP, there are now three additional PrEP prescribers in my county; at the same time, I'm not sure how they plan to have patients do the three-month followup - are they operating like primary care practices now? I'm not sure. And if my experiences working with their pharmacies are any indication of their level of understanding of PrEP, I am concerned about the quality of services and level of training that has been given to prescribers to prepare for increased demand of these services and the insurance navigation that is also needed.

At least one thing is for sure: now is the time to get up-to-date on PrEP guidelines and supportive practices if you are not there already. If you need help getting up to speed, here are some excellent resources:


My fingers are crossed that RSP will create the demand for PrEP that it appears to endeavor to create; my fingers are also crossed that we can work fast enough to create the supply of ready and set PrEP prescribers. 

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