How Should Providers Incorporate PrEP Into Busy Clinical Practices?

Not only is pre-exposure prophylaxis (PrEP) safe and effective in reducing the risk of HIV acquisition among populations at high risk of infection, it is also relatively easy to incorporate PrEP into a busy clinical practice, according to Susan Buchbinder, M.D., Director of Bridge HIV at the San Francisco Department of Public Health.

Speaking at an International Antiviral Society-USA webinar on HIV prevention, Buchbinder encouraged clinicians to screen all HIV-negative patients for HIV risk factors and consider offering PrEP to those whose sexual or drug-use behaviors placed them at risk of infection.

"Prescribing PrEP is exceedingly easy to do and shouldn't require a lot of additional time and effort," Buchbinder said.

"I think that the PROUD study showed us that it could be integrated into a busy clinical practice without needing a lot of additional counseling, and was very effectively administered," Buchbinder added.

The U.S. Centers for Disease Control and Prevention (CDC) PrEP guidelines recommend daily doses of tenofovir/emtricitabine (Truvada) as one prevention option for:

  • Men who have sex with men (MSM), who are at substantial risk of HIV acquisition.
  • Heterosexual men and women at substantial risk of HIV acquisition.
  • Men and women who inject drugs, who are at substantial risk of HIV acquisition.

"If you've got a busy practice, I recommend you ask all of your male patients, 'Do you have sex with men, women or both?' and if they say that they have sex with men or both, you can ask, 'Are you ever "bottom" without a condom?' and if they are -- outside of being in a monogamous relationship with another negative partner -- they are probably a candidate for PrEP," Buchbinder explained.

"If you then ask them 'How many sex partners have you had in the last six months?' and if they've had multiple partners, again, they're probably a candidate for PrEP," she said.

The CDC PrEP guidelines provide additional advice to clinicians wanting to screen for HIV risk factors and assess PrEP eligibility among male and female patients, including those who inject drugs.

"We do have data that PrEP works to prevent infection in injection drug users, so if you have a patient who is injecting drugs who doesn't always use clean equipment, I would definitely offer them PrEP," Buchbinder expanded. "But you're going to need to know that they're eligible to take PrEP. That means they have to have a creatinine clearance over 60, and it's good to be sure that they're not hepatitis B infected. If they have chronic hepatitis B infection, they can still take PrEP. You just need to monitor them as they come off PrEP, but they do need to come in for regular visits and not start and stop PrEP without medical guidance."

Finally, Buchbinder recommended clinicians direct PrEP-related queries to the PrEPline operated by the Clinician Consultation Center. The PrEPline provides free, expert guidance to U.S.-based clinicians who are considering prescribing PrEP as part of an HIV prevention program.

Watch the entire archived webinar available through the IAS-USA website.

Katherine Moriarty is a consultant and freelance writer, based in Vancouver. She has 10 years of experience in the intersecting fields of public health and community development, with a focus on bloodborne virus policy and programming.