Helping People Access Pr EP A Frontline Provider

Helping People Access Pr. EP: A Frontline Provider Training on Pr. EP Research, Care, and Navigation ©Please. Pr. EPMe. org. © 2020 Please. Pr. EPMe. org. All rights reserved.

Helping People Access Pr. EP: A Frontline Provider Training on Pr. EP Research, Care, and Navigation Series Modules • Module 1: Introduction to Pr. EP • Module 2: Pr. EP Science • Module 3: Client-Centered Navigation Practices • Module 4: Initial Assessments: Getting to Know Your Clients ©Please. Pr. EPMe. org. All rights reserved. • Module 5: Linkage to Pr. EP Care • Module 6: Paying for Pr. EP • Module 7: Starting Pr. EP, Adherence, and Ongoing Pr. EP Care • Module 8: Self Care and Healthy Teams

Alan Mc. Cord Please. Pr. EPMe ©Please. Pr. EPMe. org. All rights reserved.

Helping People Access Pr. EP: A Frontline Provider Training on Pr. EP Research, Care, and Navigation Module 1: Introduction to Pr. EP ©Please. Pr. EPMe. org. All rights reserved.

MODULE 1: INTRODUCTION TO Pr. EP Topics and Themes • Your work matters! • Rationale for Pr. EP navigation • Please. Pr. EPMe sexual health coaching model • Definition of Pr. EP • HIV prevention toolkit • GUEST PRESENTER: Charlie Romero Consumer Engagement, Please. Pr. EPMe ©Please. Pr. EPMe. org. All rights reserved.

MODULE 1: INTRODUCTION TO Pr. EP Your Work Matters! • Getting Pr. EP can be confusing and time-consuming. • Social issues can make it more difficult. • Create a welcoming, safe environment. • Help clients understand work within their health care system. • Client-centered Pr. EP navigation: empower people to use Pr. EP to have the sex lives they want and to stay HIV-negative. ©Please. Pr. EPMe. org. All rights reserved.

MODULE 1: INTRODUCTION TO Pr. EP Please. Pr. EPMe’s Sexual Health Coaching Model We are sex positive. ©Please. Pr. EPMe. org. All rights reserved. We meet people where they are, without judgment or assumptions. We rely on data and clinical best practices. We stay curious.

MODULE 1: INTRODUCTION TO Pr. EP Definition of Pr. EP (Pre-Exposure Prophylaxis) • Pr. EP is when an HIV-negative person takes a medication to prevent HIV infection through sex or sharing needles. • “Prophylaxis” means taking a drug before exposure to an organism that can cause an infection. • The FDA has approved the prescription medications Truvada and Descovy for Pr. EP. • Generic versions of Truvada are already available through online pharmacies. • No generic version of Descovy is available yet. ©Please. Pr. EPMe. org. All rights reserved. TRUVADA DESCOVY

MODULE 1: INTRODUCTION TO Pr. EP Truvada and Descovy Pr. EP: The Basics • Truvada = two HIV drugs: emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF). • Descovy = two HIV drugs: emtricitabine (FTC) and tenofovir alafenamide (TAF). • Truvada Pr. EP is approved for anal, vaginal, and frontal sex and sharing needles. • Descovy Pr. EP is approved only for anal sex. • CDC guidelines state that Truvada is taken once a day. Descovy is also taken once a day. • For Truvada Pr. EP, IAS-USA guidelines state the medicine can be taken around the time of anal sex. ©Please. Pr. EPMe. org. All rights reserved.

MODULE 1: INTRODUCTION TO Pr. EP Truvada and Descovy Pr. EP: Digging Deeper • Daily Truvada Pr. EP was approved in July 2012 for people ≥ 18 years. • In 2018, Truvada Pr. EP was expanded to include people who weigh ≥ 35 kg (77 pounds). • Daily Descovy Pr. EP was approved in October 2019 for adults and adolescents who weigh ≥ 35 kg (77 pounds). • Descovy Pr. EP is not approved for receptive vaginal sex. • Potential side effects are well known for both medicines. • Truvada and Descovy have no food restrictions and few drug interactions. • People can drink alcohol while on Pr. EP. • Other drugs, dosing strategies, and delivery methods for Pr. EP are being studied, including long-lasting injectable drugs. ©Please. Pr. EPMe. org. All rights reserved.

MODULE 1: INTRODUCTION TO Pr. EP Truvada and Descovy Pr. EP: Side by Side ©Please. Pr. EPMe. org. All rights reserved. Factor TRUVADA DESCOVY Use Daily, 2 -1 -1 Pr. EP Daily Individuals All sexes and genders, PWID People assigned male at birth Bones Can increase bone thinning in some Less impact on bone thinning Kidneys Not recommended if e. Cr. Cl <60 m. L Not recommended if e. Cr. Cl <30 m. L Weight May cause small weight loss May cause small weight gain Cholesterol May decrease levels May increase levels Pill Size 0. 75 inch 0. 50 inch

MODULE 1: INTRODUCTION TO Pr. EP How Pr. EP Works • The drugs in Pr. EP don’t kill HIV. • The drugs work by already being present in immune cells before HIV exposure. • Pr. EP stops HIV’s life cycle at an early step. • HIV cannot make more copies of itself and it eventually dies. • Important to take Pr. EP as prescribed so drug levels in these cells stay adequately high for protection. ©Please. Pr. EPMe. org. All rights reserved.

MODULE 1: INTRODUCTION TO Pr. EP as Part of the HIV Prevention Toolkit There are many tools people can use to help prevent HIV transmission, whatever their status. Your clients may use Pr. EP by itself or together with other tools: • Undetectable = untransmittable (U=U), treatment as prevention (Tas. P) • Post-exposure prophylaxis (PEP) • Use external or internal condoms correctly • Know their own/partner’s HIV status • Use clean syringes to inject drugs/ hormones and don’t share needles or works • • Get treated for STIs Have sex with fewer partners Talk about sexual history Have sex when sober Reduce alcohol/drug use “Cum on me, not in me” Male circumcision Remember, the HIV prevention tools that your clients use may change over time and vary with different partners or situations. ©Please. Pr. EPMe. org. All rights reserved.

MODULE 1: INTRODUCTION TO Pr. EP Undetectable = Untransmittable (U=U) • Today’s HIV drugs suppress the virus to extremely low levels in people living with HIV. • Undetectable means the virus is well under control. • Undetectable also means HIV cannot be transmitted to others through sex. • Global studies showed no transmissions: > 126, 000 acts of condomless sex among > 3, 500 mixed-status couples. • Mixed-status couples may choose U=U as their sole prevention plan. • Other prevention tools can offer added layers of protection. • U=U works when people are able to access HIV treatment and adhere to it. ©Please. Pr. EPMe. org. All rights reserved. “ Across three different studies, including thousands of couples and many thousand acts of sex without a condom or pre-exposure prophylaxis (Pr. EP), no HIV transmissions to an HIVnegative partner were observed when the HIVpositive person was virally suppressed. ” —CDC, 2017 Dear Colleague Letter

MODULE 1: INTRODUCTION TO Pr. EP Post-Exposure Prophylaxis (PEP) • PEP is a course of drugs taken daily for a month after a known or possible exposure to HIV. • It must be started within 72 hours of the exposure. • A PEP prescription must be obtained from a medical provider. • Clients may need to explain PEP and refer clinicians to these resources: - Clinician Consultation Center’s PEPline: 888 -448 -4911 - 2016 Federal PEP Guidelines • Seek PEP through a doctor’s office, local STI clinic, other public clinic, emergency room or urgent care facility. • Patient assistance programs are available to help with the cost. • Some people may want to transition from PEP to Pr. EP. ©Please. Pr. EPMe. org. All rights reserved.

MODULE 1: INTRODUCTION TO Pr. EP GUEST PRESENTER Charlie Romero Consumer Engagement, Please. Pr. EPMe he/she/they/ze ©Please. Pr. EPMe. org. All rights reserved.

MODULE 1: INTRODUCTION TO Pr. EP Charlie Romero Please. Pr. EPMe ©Please. Pr. EPMe. org. All rights reserved.

Thank you for your time! For further reading and tools, download the resource guide accompanying this module. Please complete the post-session survey. Thanks! ©Please. Pr. EPMe. org. All rights reserved.

Acknowledgments and Permissions Please. Pr. EPMe is grateful to the National Library of Medicine and the National Coalition of STD Directors for funding the development and production of this course. Updates and permissions: • All efforts have been made to provide current data and information. Training modules will be updated as Pr. EP research, access, and clinical guidelines evolve. • It is intended that these modules and individual slides be used as prepared, without changes in either content or attribution. We ask users to honor this intent. • The complete slide set is available for download at www. pleaseprepme. org/prepnavtraining. ©Please. Pr. EPMe. org. All rights reserved.