TelePrEP Offers Easy, Private Access to HIV Prevention Pill
About 300,000 Philadelphians who don’t have HIV are at risk of acquiring it, according to the Philadelphia Department of Public Health. But too few people have been able to access a medication that can substantially lower that risk, particularly among vulnerable populations. It’s called PrEP – short for pre-exposure prophylaxis.
Einstein Medical Center Philadelphia is now working in tandem with the health department to make it easier for Philadelphia residents to acquire this medication through a free program called TelePrEP.
As the name suggests, Philadelphians who want access to PrEP medications can receive them through the convenience and privacy of telehealth visits. The program is open to any Philadelphia resident over 16, regardless of insurance status.
Removing Barriers
“The mission of our TelePrEP program is to be a completely accessible service for every single person in Philadelphia, which means lower-barrier access to PrEP in an affirming and culturally competent way, giving patients a choice and control over their sexual well-being,” says Hussein Safa, MD, medical director of the TelePrEP program and Einstein’s Pride Program.
TelePrEP, administered through Philly Keep on Loving, the health department’s online sexual wellness platform, is the first of its kind in the region. Community members begin their PrEP journey through the website by calling, texting or directly scheduling a telehealth visit.
After that, a representative from Einstein Philadelphia contacts the person to have a test kit for HIV and other sexually transmitted infections sent to their home. (Testing in a lab is also an option.)
The website also provides Philadelphians with access to free sexual wellness products, including condoms and lubricants.
After a telehealth visit and lab results are completed, an Einstein provider prescribes PrEP. The medication is delivered in discreet packaging to the home, or people can go to a pharmacy of their choice. The FDA-approved PrEP medications include oral Truvada and Descovy. Medications also include the long-lasting injectible Apretude, which must be administered in person at Einstein’s Community Practice Center on the Einstein Philadelphia campus.
“This service is crucial to ending the HIV epidemic and curbing rising sexually transmitted infections,” Dr. Safa says. “We hope it will help many people start PrEP, lower the risk of acquiring HIV, and receive regular sexually transmitted infection screening when they otherwise would not have been able to through brick-and-mortar settings.”
Goal: Ending the HIV Epidemic
The Philadelphia TelePrEP program is designed to be a part of the health department’s “Ending the HIV Epidemic” strategy of prevention. A key goal of the initiative is to address the gap between the number of people who would most likely benefit from PrEP and the number who are taking it among high-priority groups, including men who have sex with men, people who inject drugs, at-risk heterosexuals, and transgender women.
Aviva Joffe, MSW, LSW, program director of the Immunodeficiency Center at Einstein Philadelphia, hopes TelePrEP will help her reduce the number of difficult conversations she has to have with newly diagnosed HIV-positive patients who perhaps did not know about PrEP, thought it was not for them, and never had a conversation with a healthcare provider about sexual behavior and associated risks.
“Too many patients have looked back at me with shock, sadness, and tears in their eyes when they learn that there is a medication they could have taken to prevent getting HIV,” she says.
But it isn’t too late for countless others, who might avoid such a diagnosis through candid, non-judgmental conversations with a healthcare professional.
Local statistics suggest that those conversations seem to happen only rarely. According to the health department, in Philadelphia only 35% of men who have sex with men, 29% of people who inject drugs, 1.6% of heterosexuals, and 56% of transgender women have ever discussed PrEP with a healthcare professional.
Targeting Racial and Gender Inequities
The numbers also point to racial and gender inequities in terms of who gets the message about PrEP. In 2022, 63% of people newly diagnosed with HIV were Black/African American, yet only about 15% of PrEP users fall into that category.
Those inequities play out in several ways. For example, because of systemic issues of poverty, racism, and oppression, Black and Latinx people tend to be underinsured or uninsured, says Dr. Safa.
They may not have easy access to the health care system, and they often mistrust health care providers, he says. They may have experienced trauma or judgment.
“We wanted to develop the TelePrEP program to address these racial and gender inequities in PrEP uptake,” explains Joffe.
This initiative, she says, offers “low-barrier, convenient, sex-positive, informative, culturally responsive, empowering and radically accessible PrEP services so that people not being served by the current system can access this HIV prevention modality.”
Providing Privacy
TelePrEP is also designed to eliminate other barriers to access. In addition to those who are hesitant to have a conversation with a health care provider, Dr. Safa says, others are reluctant to pick up a prescription from a pharmacy out of fear of judgment.
Young people, too, might still be on their parents’ insurance and worry about the consequences of being on PrEP if their parents see what medical visit or medication has been charged to their insurance plan.
The new TelePrEP services are available to everyone in Philadelphia – including those erroneously thought to be “not the kind of person” who contracts HIV. About 21% newly diagnosed with HIV were assigned female at birth, yet less than 1% of heterosexual cisgender women (someone assigned female at birth who identifies as a woman) have used PrEP.
“In 2022, in Einstein’s Immunodeficiency Center, we saw 28 patients newly diagnosed with HIV,” says Dr. Safa. “The youngest was 15 and the oldest was 71. Two-thirds were male, and one-third were female. Over half reported heterosexual sex as their HIV risk factors.”
He adds, “We have to get rid of rigid, stigmatizing conceptions of the type of person who is ‘at risk’ for HIV and offer testing and prevention services to everyone.”
For more information on how to access TelePrEP, visit PhillyKeepOnLoving.com.
Learn more about the Einstein Pride Program for LGBTQ+ healthcare.
Jeff Meade contributed to this article.
