A Kansas City, Kan., healthcare organization is seeing slow, but growing interest in a unique new service it launched last month to expand access to antiretroviral medication that can be used to reduce the risk of HIV infection — a method known as pre-exposure prophylaxis (PrEP).
Sharon Lee, a doctor at Family Health Care, created the Friday-only service, or the PrEP Care clinic, to help people seeking the medication get a prescription because some doctors are hesitant or unwilling to do so.
"It appears that there is a lack of pickup [with PrEP] among physicians," Lee said. "A lot of people were having difficulty because their doctors did not want to prescribe the medication because maybe they were unfamiliar with the medication and not comfortable prescribing it."
PrEP currently comes in the form of Truvada, a pill containing antiretroviral drugs that when taken daily as directed has been shown to reduce HIV transmission by more than 90%, according to the Centers for Disease Control and Prevention (CDC). In May, the CDC issued expansive medical guidelines recommending that doctors prescribe Truvada to patients at high risk to help reduce the risk of HIV infection along with the use of condoms. The CDC also reported that fewer than 10,000 prescriptions have been written for the medication since the FDA approved it to be used for PrEP in July 2012.
HIV/AIDS advocacy groups, researchers, and some public health officials say PrEP is an important tool in the fight against the virus and has the potential to make significant declines in new infections, but critics and some doctors worry it will result in riskier behavior like condomless sex and warn that the drug doesn't protect against other STIs. The high cost of the medication — about $1,300 per month — has also been an issue, although it is covered by most insurers and available through an assistance program by the drug's maker, Gilead Sciences.
"I'm sure some doctors may have some misgivings for reasons other than familiarity with the drug," Lee said. "Regardless, I was finding folks whose primary doctors were not willing to provide the medicine and there are probably more of those folks out there. There is a need, I believe, for there to be more access to try this prophylaxis."
Lee said the clinic's goal is to help provide PrEP to people who request it, but that clients seeking the PrEP Care services will not become full-time patients of Family Health Care, which focuses its services on the area's underserved.
Rather, Lee said the clinic will offer clients the prescription in a situation where they are checking back and consulting with their primary physician. With that, the clinic will follow the CDC guidelines and do extensive testing prior to prescribing the medication and check-ups every three months for more testing and monitoring for side effects. The first visit will cost about $300.
"We want them to be aware this is just one piece of overall prevention strategy and that they should be using condoms and clean needles in addition to the medicine," Lee said. "The medicine can't do it on its own."
Prior to starting the clinic, Lee said she was already prescribing Truvada for PrEP to the partners of Family Health Care patients in sero-discordant relationships (when someone who is HIV-negative is in a relationship with someone who is HIV-positive.)
Lee said she has not received any direct criticism from other doctors for prescribing the medication and offering services to get more people on it.
"First I should say that I haven't had direct criticism in terms of people saying that I should not do this," she said. "I've had indirect, where someone has asked me, 'Well hasn't someone said this is wrong because you're gonna be letting too many people use this instead of condoms?' or 'Don't you feel bad about the fact that someone might get HIV because they're using this medicine?' I don't think that there's a lot of that, but I think there's some."
She has, however, received calls and letters of support for her work. Doctors at other medical organizations in the state have contacted her to talk about how they too could offer PrEP services.
As of Monday, Lee said she has not had any appointments for PrEP, but that she anticipates the clinic's first clients in the coming weeks because of the amount of calls they've received asking for more information since it opened July 25.
"It's going to take some time," she said. "This new way of doing it as public service has not been picked up on yet, but it will come around. I'm not at all concerned about that."