Talk to your doctor or nurse practitioner about why you are interested in PrEP. This might require sharing some pretty personal information, and we know that can be a barrier to guys when talking to their primary healthcare provider not just about PrEP, but sexual health in general. If you’re not comfortable sharing details about your sex life with your primary care provider, contact HIM and we can try to help connect you with a gay-friendly provider, or with providers here in Vancouver who might be more familiar with PrEP, and more willing to work with you to consider it as an HIV prevention strategy for you. Remember that the most important thing here is that you have to have a prescription for PrEP, and it does require some follow up, so having a regular provider is essential.
Once you and your healthcare provider decide PrEP is a good choice for you, they’re going to need to have you complete some really important tests. These tests are listed below, and you should make sure you know about them, just in case your doctor isn’t familiar with all the steps to prescribing PrEP. If your doctor doesn’t ask for one of these tests, it’s essential that you let them know, because not getting one of them could cause big complications later on. Here is the printable fact sheet that has some helpful hints on talking to your provider about PrEP, and a brief list of all the required tests you need before and after starting PrEP- just in case they aren't familiar with PrEP, and aren't sure what tests you need.
Before Starting PrEP: The Tests
- HIV: It’s essential you get an HIV test before you start PrEP. If you start PrEP and are positive but don’t know it, it can be a big issue. Even though Truvada is used as an HIV treatment drug, on its own it isn’t powerful enough to control the virus. This means if you’re taking PrEP but are HIV positive and don’t know it, the virus could mutate and become resistant to Truvada. Because Truvada is considered a ‘frontline’ medication for HIV treatment (because it’s so safe and well-tolerated), it’s important that it is only reserved for proper use in combination with other drugs for HIV treatment and prevention. After you take your HIV test, your provider will likely recommend that you avoid any sexual activity that can pass HIV for about seven days after you start Truvada for PrEP. This is just to make sure you have enough medication in your bloodstream to protect against HIV before you have sex.
- Hepatitis B: Truvada can also cause complications for guys who have Hepatitis B, even if they don’t know it. It can also cause complications for guys who contract Hep B after they start PrEP. So, another essential test is a Hep B test if you haven’t been vaccinated, or what’s called a ‘titer reading’ if you have been vaccinated. A titer reading tells your provider how active your vaccination is, and will help them determine if you should be re-vaccinated. If you haven’t been vaccinated against Hep B., you will need to be before you can start PrEP.
- Kidney function test: because a very small number of guys will have decreased kidney function as a side effect of PrEP, your provider should test your kidney function before you start PrEP, and also one month after. This will let you and your provider know if it’s safe to start, and will also let you both know very quickly if any kidney issues arise. The specific test your doctor should ask for will measure (or estimate) how efficiently your kidney’s clear a kind of protein called ‘creatinine.’
- STI tests: STI screening is also part of initiating PrEP, both when you start and for however long you take the medication. REMEMBER: PrEP DOES NOT PROTECT AGAINST ANY OTHER STIs! Vancouver is currently experiencing a significant syphilis outbreak, and rates of other STIs here remain high. For many reasons, you should get tested every three months. One great thing about PrEP is STI testing becomes a more regular part of your overall healthcare regimen!
While You’re on PrEP: The Tests
- HIV: even though you’re taking PrEP to prevent HIV transmission, you’ll still need to get tested for HIV every three months. Because PrEP is still pretty new, researchers are following users closely to make sure it’s as effective as the studies indicate. We also know that all HIV prevention methods, including condoms and PrEP, will not work 100% of the time. Getting tested for HIV every three months ensures that in cases where PrEP didn’t work to prevent HIV transmission, guys can get the treatment they need immediately.
- STI tests: Because researchers have established that some (though not most) guys might change how they use condoms after they start PrEP, you’ll need to get tested for all STIs every three months, even if you’re still using condoms. These are part of the guidelines established by Health Canada, so remember that if your doctor or nurse practitioner isn’t asking for these tests, they’re not following the guidelines, and you might want to find a provider who knows more about PrEP. As we have noted before, STI rates in Vancouver are high, and some, like syphilis, are now considered outbreaks. It’s important to get your STI tests for your PrEP regimen, but all guys should be getting tested a lot more frequently, and taking more steps to protect themselves and others from STI transmission through safer sex methods.
- Kidney function test: just like we talked about above, PrEP can impact kidney function for a small number of guys. Usually this happens pretty soon after you start the medication, but it can also develop later on, so your provider should be making sure you have your kidney function / creatinine clearance tested every three months as well.
PRIVATE INSURANCE COVERAGE FOR PrEP IS ENDING
Private insurance coverage for PrEP in BC is expected to end in January, 2018. If you have an eligible refill (especially if it is a three month refill) we advise you try to fill it as soon as possible, as private coverage is expected to end, and it may take some time for you to obtain a new prescription through the publicly funded program. If you have questions or need assistance in transitioning from private insurance to publicly funded PrEP, call HIM at 604-488-1001, and we can help connect you with a Health Promotion Case Manager who can help you navigate the process.
PUBLIC PrEP PROGRAM FOR GAY, BI, AND OTHER MSM: HOW TO ACCESS
PrEP coverage in BC has begun, but some components of the public funding plan and access continue to be under development. Rollout of publicly funded PrEP began on January 08, 2018, but please be advised that even after January 08, there may be delays as the new program is implemented. If you have an eligible prescription refill, either through private insurance or generic importation, we are advising you to fill it ASAP to help cover your PrEP needs throughout these delays.
- If you are seeing Drs. Hall, Hull or Winata at the HIM Health Centre on Davie, you will need an appointment to update your prescription and receive further information about how to access publicly funded PrEP. Please note that appointments are booked several weeks in advance, so please allow for this. Please stick with the appointments you already have booked, and do not double book an appointment or request a different booking. As we have several hundred clients in this position you will be transitioned over to publicly funded PrEP at your next scheduled appointment. Make sure you have enough medication to cover you until that time. Your doctor likely have gave you a prescription for enough medication to cover until your next appointment.
- For information about accessing publicly funded PrEP coverage for individuals who have prescriptions from physicians NOT listed above, or for guys living outside of Metro Vancouver, please see the "HOW TO ACCESS..." section below this one.
- For guys living in the Metro Vancouver area, once you are on publicly funded PrEP, prescriptions will be filled and medications picked up by you at St. Paul’s Hospital.
- We do not want you to run out of medication, so if you are currently nearing the end of your current medication supply, have a current prescription with eligible refills, and access it via generic importation, we are advising that you should re-order an additional prescription while we await more details about accessing publicly funded PrEP.
- If you aren’t yet on PrEP, remember that condoms are another very effective method to prevent HIV transmission. HIM has many different kinds of condoms available FOR FREE at all of our five health centres throughout the Lower Mainland, as well as many bars and clubs in the Davie Village.
- If you are concerned that you may have had a high risk exposure to HIV (like sex without PrEP or a condom with an individual who is NOT undetectable, and who is either HIV positive or of unknown status), PEP may be an option. PEP MUST BE STARTED WITHIN 72 HOURS OF EXPOSURE TO HIV TO WORK, and ideally should be started ASAP. Information about PEP can be found here: http://checkhimout.ca/PEP/
HOW TO ACCESS PUBLICLY FUNDED PrEP THROUGH YOUR OWN DOCTOR OR NURSE PRACTITIONER (including for guys outside of Metro Vancouver):
How to access no-cost PrEP in BC via the Centre for Excellence's Drug Treatment Program (DTP):
1. Visit your doctor/ nurse practitioner to be assessed for starting or continuing PrEP. Complete the required screening tests.
2. Your MD/NP must call the CFE DTP at 604-806-8515 to request the enrollment/ prescription form and provide a fax number. The DTP will FAX this form to your MD/NP*
3. Your MD/NP completes the form and faxes it back to DTP at 604-806-9044
4. DTP reviews the request and fills the prescription. The medication can be picked up at St. Paul's Ambulatory Pharmacy in Vancouver, or shipped to a patient's community pharmacy elsewhere**
*Note: having doctors call DTP for the requisition to be faxed is only temporary -- it will be available on the CFE website eventually
**Note: the approval and dispensing process is not same-day like most pharmacy experiences. Anticipate a week or more between when the requisition is submitted and when the medication is available to the patient