PrEP Clinic improves care, follow-up for patients at risk for HIV

A clinic at University of Iowa Health Care–Iowa River Landing in Coralville now makes it easier to treat and monitor patients who have a higher risk of HIV infection.

The PrEP (Pre-Exposure Prophylaxis) Clinic offers Truvada, a drug approved by the Food and Drug Administration in 2012 as a preventive medication for HIV after having been long-established as a treatment for those who had already tested positive for HIV.

The PrEP Clinic is unique in that it is pharmacist-based. Working in collaboration with a patient’s primary care provider, a pharmacist independently monitors a patient’s medication therapy and serves as the direct provider for necessary follow-up visits.

As an HIV-preventive medication, Truvada is prescribed for adults who are at a higher risk of getting HIV:

  • Individuals whose sexual partners are HIV-positive
  • HIV-negative men with male sexual partners
  • Transgender women with male sexual partners
  • Individuals who have multiple sexual partners
  • Intravenous drug users

However, Truvada therapy requires regular three-month follow-up appointments, which can be difficult, notes Michelle Miller, PharmD, the primary pharmacist and direct care provider with the PrEP Clinic.

“One of the barriers to more people being prescribed Truvada is the monitoring involved,” Miller says. “Primary care practices typically are quite busy, so scheduling a timely follow-up can be a challenge for patients and providers. Plus, there are required regular blood draws and other lab work, and that can all take time.”

The PrEP Clinic helps solve these problems by running lab tests on-site and providing the long-term monitoring required for patients on Truvada—easing the demands placed on primary care providers’ time, according to Miller.

“Now, providers can identify their patients who are at high risk for HIV and send them to us. We typically see new patients within one to two weeks,” Miller says. “As a pharmacist, I can prescribe Truvada and provide the necessary follow-up care through the practice agreement we established when we developed the PrEP Clinic. This is much simpler and easier for providers, which should help increase utilization of this therapy.”

This approach benefits patients as well. At the PrEP Clinic, patients self-collect their oral- and rectal-swab samples for lab testing, making the process convenient and comfortable.

“The clinic visit is streamlined and efficient. Patients come in, undergo a blood draw, self-collect a sample, see the pharmacist for a follow-up, and get their prescription,” Miller says.

It’s an innovative practice model that is similar to a pharmacotherapy clinic or anticoagulation clinic—both of which use pharmacists to improve access, quality, and outcomes, notes Nicole Nisly, MD, medical director of the PrEP Clinic.

“It’s a collaborative and effective way to care for these patients,” Nisly says. “Patients are assured timely and convenient access to care and follow-up, and it allows a patient’s primary care provider to co-manage their patient’s care with a pharmacist knowledgeable about medication risks, benefits, and side effects.”

To schedule an appointment with the PrEP Clinic, call 319-384-7444.