Wednesday, February 11, 2015

HIV PEP Use Up 26% in SF; No Sero-Conversions
[Correction: My math was off. The increase is actually 34%.]

Israel Nieves is the San Francisco Department of Public Health's go-to guy for HIV prevention questions including PEP, post exposure prophylaxis, not to be confused with PrEP, pre-exposure prophylaxis. 

PEP is a drug cocktail given to at-risk individuals after they've had barrier-free sex with either a person of unknown HIV status or is poz, or they were stuck with a syringe needle, and should be started as soon as possible after exposure to HIV.

One benefit to PEP instead of PrEP for certain persons is that it's a short-term, one month drug regimen versus a daily dose of PrEP medicines. If your sex life revolves around regular HIV negative partners but one night at a party you hookup with someone outside your sexual network, PEP is better for your prevention needs.

On the other hand, if you're negative and enjoying multiple partners of unknown sero-status or one special dude who's poz, PrEP is what you should be on.

Nieves was asked to explain to me the number of annual PEP starter cocktails distributed by DPH, costs of providing the drugs, followup testing determining if sero-conversion was averted, and budget allocation for PEP promotion. 

Bottom line: PEP use is up 26% since 2012 and no sero-conversions have been recorded. Good HIV news, wouldn't you say? Yes, I do!

Here are the details Nieves provided to me today:

"San Francisco General Hospital Urgent Care Clinic:
"The Urgent Care Clinic at SFGH provided 73 PEP starter packs to clients in 2014.
"Unfortunately, the clinic does not have information about any PEP provided to clients before this time, as there were not systems in place to systematically track this before 2014.
"SFGH does not have a standalone budget for PEP as it is incorporated into our current activities for drug purchasing. Truvada is used for PEP, PrEP and Treatment and we do not see them as different line items. 

"San Francisco City Clinic (SFCC):
2012  - 446 PEP starter packs
2013 – 476 PEP starter packs
2014 – 599 PEP starter packs
"Information prior to 2012 is not available electronically as they used paper charts. There is not separate line item budget for PEP promotional materials.
"We charge a $10.00 flat fee for services at SFCC.  PEP patients who return to SFCC are not charged the fee at their PEP follow-up visit.  No one is turned away if they can not pay the $10 flat fee.

"SFCC recommends that patients have an HIV test after they complete the PEP course. Sometimes they come to SFCC, sometimes they go to their primary medical doctor.    

"SFCC provides 2-day starter packs (48 hrs) and a prescription to the person. 

"They currently purchase Truvada using 340b pricing for approx. 441.25/30 pills; or $14.70/pill (approx. $30.00 for a 2-day starter pack).  

"Prior to 2012, we used combivir for PEP and I don’t know how much we paid for combivir – and it probably changed year to year.

"SFCC does not have any documented cases of patients who were HIV neg at the time of PEP initiation and were HIV positive on a test conducted 1-3 weeks after completing their PEP course."

If you need more info about PEP or other HIV concerns, please contact Nieves directly:

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