The HIV prevention medication PrEP — short for pre-exposure prophylaxis — has played a critical role in reducing the number of new HIV infections in recent years. It is highly effective when taken as prescribed every day, lowering the risk of sexual transmission and intravenous drug transmission by 99% and 74%, respectively.

Staying on track with PrEP treatment includes not only taking the medication as prescribed, but also regularly attending all follow-up appointments and completing recommended lab tests. Here’s an overview of ongoing medical care related to PrEP.

Note that PrEP is distinct from PEP — post-exposure prophylaxis — a prevention medication for emergencies and accidental exposures. Learn more about PEP.

How do I get started with PrEP?

If you think PrEP may be right for you, make an appointment with your doctor or other healthcare provider as a first step. (Check with your provider about the possibility of telehealth appointments, if interested.) They can write you a prescription for PrEP and conduct an HIV test, which is required to begin taking the medication.

If you do not have a provider or are unable to get a prescription from your doctor, the following resources can connect you with a provider who will prescribe PrEP for you:

• pleaseprepme.org

• preplocator.org

• aidsvu.org

What are my options for PrEP medication?

There are several FDA-approved oral medication options — Truvada®, Descovy®,  and a generic for Truvada — and as of December 2021, PrEP is now available as an injectable treatment option called cabotegravir (Apretude®).

For those who find it difficult to remember to take a pill every day, the injectable form may make it easier to stay on track with PrEP treatment. However, oral PrEP continues to offer highly effective prevention for anyone at risk of HIV infection.

Always consult with a doctor if you are interested in switching from one form of PrEP to another.

What is the typical schedule of medical appointments when taking PrEP?

Work with your provider to determine the frequency of your follow-up appointments. A typical schedule often consists of the following:

• The initial appointment

• First follow-up appointment between 2-4 weeks

• Two-month follow-up appointment

• Ongoing follow-up appointments every three months

What happens at the initial intake appointment?

If you are interested in getting started with PrEP, the first appointment will include an overview of PrEP as well as HIV testing and other lab work. If you qualify for PrEP and can commit to start taking the medication as prescribed, your doctor can write a prescription right away.

The baseline lab work includes the following:

• An HIV test, to confirm that you do not have HIV at the beginning of your PrEP treatment

• Testing to screen for other sexually transmitted infections (STIs), including chlamydia, gonorrhea, and syphilis

• A blood test to measure kidney function (for those prescribed oral PrEP medications)

• A blood test to measure cholesterol and triglyceride levels (for those prescribed oral PrEP medications)

What happens at the first follow-up appointment?

Your provider will have you come in for a follow-up appointment between 2-4 weeks. This appointment is an opportunity to discuss your experience with the medication so far, including side effects. It’s also a good time to share any other concerns, such as financial difficulties or medication adherence. Your provider will likely be able to refer you to resources.

What happens at ongoing follow-up appointments?

If you are taking oral PrEP, you will have follow-up appointments every three months. At these appointments, your doctor will:

• Conduct an HIV test and assess you for symptoms of acute HIV infection to confirm that you still do not have HIV.

• Provide a prescription or refill authorization of daily oral PrEP medication for no more than 90 days.

• Discuss any challenges with medication adherence and answer any questions you may have.

• Conduct screening for other STIs including syphilis, gonorrhea, or chlamydia.

At the six-month mark, your doctor will likely measure kidney function. (Kidney testing may be more frequent depending on individual health factors.)

They may also ask about your interest in continuing with or stopping the medication. It is important to always consult with a provider before discontinuing or restarting PrEP so that they can evaluate your overall health and review lab work.

What if I have difficulty affording PrEP or related medical care?

PrEP continues to become more accessible. In addition to the availability of generic PrEP options and expanded health insurance coverage of PrEP, the following resources can help lower the costs of HIV prevention medication.

• Many states have patient assistance programs to help people with a variety of insurance statuses access PrEP and related medical services at little to no cost. Read our previous blog for more on how to apply for state-funded PrEP assistance programs.

• Many medication manufacturers offer patient assistance programs to offset the cost of medication. For example, Gilead, the manufacturer of brand-name Truvada, has the Gilead Advancing Access® program, which offers a copay card for those with insurance and a Medical Assistance Program for those who are uninsured.

• The Ready, Set, PrEP program provides PrEP at no cost to eligible individuals without insurance coverage of prescription medications.

Alto on your side

Alto is here every step of the way to make it as easy as possible to follow the treatment plan your doctor recommends. Our pharmacists have deep expertise in HIV treatment and prevention and can help you get started with oral PrEP and continue treatment.

We’re available to answer any questions you may have between your follow-up appointments. In addition, we will coordinate with your doctor and your insurance provider, if applicable, to ensure that you’re receiving the best PrEP option for your needs at the best price.

To learn more, reach out any time through Alto’s in-app messaging or phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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