Pill To Mouth- Barriers to obtaining HIV Pre Exposure Prophylaxis in a Community Based Sexual Health Clinic Providing Services for Gay, Bi and Trans men

HIV Pre-exposure prophylaxis (PrEP) was approved by the FDA in 2012.The Affordable Care Act created an opportunity for access to PrEP. Centers for Disease Control and Prevention (CDC) recommendations were utilized to implement a practice protocol to assess the feasibility of a PrEP program in an urban, sexual health clinic for men 18 and over who identify as gay, bisexual or transgender. Appointments were offered Monday through Saturday, all required testing and counselling was completed on site. A financial counselor assisted clients in obtaining healthcare coverage. All clients who met the guidelines left the clinic with a prescription for PrEP.

N=75; Age range: 20-68; Ethnicity: 60% Caucasian, 30% Hispanic, and 1% Black. Condom less sex was reported by 87%. Time range from obtaining prescription to starting drug: 1-30 days. Clients who were unable to obtain drug within seven days of HIV testing required a repeat tests. Barriers to obtaining PrEP included:  high insurance co-pay, specialty tier classification, prior authorization, PrEP not covered under the formulary, specified pharmacy only, drug mailed to clinic, a nurse practitioner to verify medications via phone, and completion of prior authorizations.

For PrEP to be effective in reducing the transmission of HIV, obtaining medication needs to be simpler. Strategies to reduce wait time for starting PrEP include: meeting with the financial counselor before clinical assessment to reduce repeat safety tests; providing a copayment card with the prescription; using a prepared statement of CDC recommendations for all prior authorizations and ability to dispense PrEP on site.