The startup Nurx is now allowing patients in California to obtain a prescription for PrEP through your phone, without having to see your physician. PrEP stands for Pre-exposure prophylaxis and is when individuals at very high risk for HIV take HIV medications to lower the chances of getting infected. The drug for PrEP therapy is Truvada.
Pre-exposure prophylaxis and the stigma of seeing a physician is a problem I’ve seen played out in the Emergency Room. In my career I’ve had cases where patients came to the ER for vague complaints only to realize the main reason was for HIV testing. Often times the reason for testing was because they wanted to have a child with a HIV positive partner (sexually active) but were too ashamed to discuss this with their physician because they assumed it would be frowned upon.
Grant and Smith have a nice review article on PrEP and the CDC also provides guidance on PreP. The National Library of Medicine has a great free HIV Guidelines app for physicians and the CDC has a HIV medication reminder app for patients.
So who exactly is PrEP for? The CDC recommends PrEP be considered for those who are HIV negative but are having an ongoing sexual relationship with an HIV positive partner. The CDC further details out other people who should be considered for PrEP:
This recommendation also includes anyone who: isn’t in a mutually monogamous relationship with a partner who recently tested HIV-negative, and is a: gay or bisexual man who has had anal sex without using a condom or been diagnosed with an STD in the past 6 months, or heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (for example, people who inject drugs or women who have bisexual male partners).
PrEP is also recommended for people who have injected drugs in the past 6 months and have shared needles or works or been in drug treatment in the past 6 months.
You can see from the CDC’s guidelines that a substantial patient population is covered. Unfortunately, many people don’t feel comfortable discussing their social history with their physicians and an opportunity for them to seek treatment for PrEP could be missed. Also — it’s widely know there are large bodies of physicians who do not feel comfortable starting patients on PrEP.
Nurx is trying to start patients on PrEP who don’t feel comfortable going to their physician or their physician doesn’t feel comfortable starting them on PrEP. In order to receive PrEP therapy, Nurx asks questions about risk factors and your medical history. Many of the risk factors they ask are related to the CDC’s guidelines. Nurx has physicians on staff that will then review your answers and then determine if PrEP is appropriate for you. Subsequent labs then have to be done and continued every 3 months in order to keep receiving PrEP therapy. Nurx states their physicians will continue to remain in touch with their patients who are on PrEP therapy. This entire process, other than going to have labs drawn, can be done from your smart phone.