By Gina Shaw
You don’t have to be an HIV expert to administer pre-exposure prophylaxis (PrEP) for the prevention of HIV infection in high-risk populations, said Brandon Patchett, PharmD, the senior director of pharmacy services for the Los Angeles-based AIDS Healthcare Foundation, during a session at the 2020 NASP Annual Meeting & Expo Virtual Experience.
“Pharmacist-administered PrEP programs are becoming more and more common across the country,” Dr. Patchett said. In most states, pharmacists are allowed to provide pharmaceutical care by entering into collaborative practice agreements with medical providers. “Getting all providers competent in the provision of PrEP can increase the uptake of this therapy. As specialty pharmacists, it’s particularly important that we strive to identify PrEP candidates.
”Consistent PrEP use by high-risk individuals has been found to reduce the risk for transmitting the HIV virus to sexual partners by 92% to 100%, Dr. Patchett said, although it does not prevent the transmission of other sexually transmitted infections (STIs) (N Engl J Med 2010;363[27]:2587-2599; Lancet 2016;387[10013]:53-60). Two regimens are approved for PrEP: tenofovir-emtricitabine (TDF/FTC; Truvada, Gilead) and tenofovir alafenamide/emtricitabine (TAF/FTC; Descovy, Gilead).
In 2019, the CDC reported that awareness of PrEP among urban-area men who have sex with men (MSM) increased from 60% to 90% between 2014 and 2017, and use of PrEP in this population increased from 6% to 35% over the same period (MMWR Morb Mortal Wkly Rep 2019; 68[27]:597-603). “That means that one-third of the MSM population in these 20 urban areas studied [is] now using PrEP, which is great,” Dr. Patchett said. “However, we must still continue to push its awareness and use in high-risk populations, particularly vulnerable demographic subgroups like Black and Hispanic populations.”
Many pharmacies may receive a significant number of referrals for post-exposure prophylaxis, using retroviral therapy as a one-time treatment for possible HIV exposure, he noted. “This offers an opportunity for the pharmacist to provide PrEP screening and counseling,” he said. “We are in the ideal position to initiate successful PrEP. In general, it’s quite easy to manage.”
Potential candidates for PrEP have the following risk factors:
- Sex with a person known to have HIV
- An STI within the past six months
- A high number of sexual partners
- A history of inconsistent or absent condom use
- Commercial sex work
- Injecting partner with HIV
- Sharing injection equipment
To be clinically eligible for PrEP, patients must meet the following screening criteria:
- A negative HIV test
- No signs or symptoms of acute HIV infection
- Creatinine clearance ≥60 mL/min
- Status documented for hepatitis B virus (HBV) infection and vaccination (an abstract recently presented at the Conference on Retroviruses and Opportunistic Infections indicates that PrEP is significantly protective against HBV)
“Flexibility is the key to PrEP retention, and in addition to screening and helping start patients on therapy, pharmacists are in the ideal position to help make sure patients are adherent to PrEP,” Dr. Patchett said. “Quarterly HIV testing and screening for STIs are advised as good practice to prevent the development of HIV acquisition resistance. You can review these results and communicate with patients via telehealth. Every effort should be made to avoid discontinuing PrEP or withholding it from a person who is at risk of acquiring HIV.”
