PrEP During COVID-19

Cross-posted from Centers for Disease Control and Prevention

May 15, 2020

Dear Colleague:

The Centers for Disease Control and Prevention (CDC) understands that its partners in HIV prevention are facing unprecedented challenges and demands as we continue to battle the COVID-19 pandemic together. While some clinics and HIV prevention providers have adapted to changing circumstances by offering expanded phone triage and telehealth services, other clinics that provide pre-exposure prophylaxis (PrEP) services have had to reduce hours, eliminate or reallocate staff resources, or temporarily close. CDC has developed guidance for providing PrEP when facility-based services and in-person patient-clinician contact is limited. For programs experiencing disruption in PrEP clinical services, CDC offers the following guidance for clinics to consider in the context of local resources and staff availability.

1. Reducing the number of new HIV infections remains a public health priority, and providing PrEP care is an essential health service. Clinicians should continue to ensure the availability of PrEP for patients newly initiating PrEP and patients continuing PrEP use.
2. Quarterly HIV testing should be continued for patient safety. Lab-only visits for assessment of HIV infection and other indicated tests for the provision of PrEP are preferred. When these are not available or feasible, CDC recommends considering two additional options.
   • The first option is a home specimen collection kit for HIV and sexually transmitted infection (STI) tests, which is covered by most insurance plans and can be ordered by clinicians. Some laboratories (such as Molecular Testing LabsTM) have validated protocols for testing home-collected samples for the panel of tests required for those initiating or continuing PrEP. Specimen kits are mailed to the patient’s home and contain supplies to collect blood from a fingerstick or other appropriate method (e.g. self-collected swabs and urine). The kit is then mailed back to the lab with test results returned to the clinician who acts on results accordingly. This laboratory-conducted test is sensitive enough to detect recent HIV infection.
   • The second option is self-testing via an oral swab-based test. Although this type of HIV self-test is usually not recommended for PrEP patients due to its lower sensitivity in detecting recent HIV infection during PrEP use, clinicians could consider use of these tests when other options are not available.
3. When HIV-negative status is confirmed, consider providing a prescription for a 90-day supply of PrEP medication (rather than a 30-day supply with two refills) to minimize trips to the pharmacy and to facilitate PrEP adherence. Several programs are available to help provide affordable PrEP medication including Ready, Set, PrEP, a nationwide program that makes PrEP medications available at no cost to individuals who qualify and lack prescription drug coverage; state drug assistance programs; and Gilead’s Medication Assistance Program (MAP)Exit Disclaimer, which assists eligible HIV-negative adults in the United States who require assistance paying for PrEP.
4. If a PrEP clinic is considering closing or suspending services temporarily, health care providers should establish referral relationships with other clinics, telemedicine services, or pharmacies so that clients may remain engaged in PrEP care.

If PrEP clinical services have not been disrupted, providers should continue to follow recommendations outlined in the 2017 PrEP Clinical Guidelines and Clinical Providers’ Supplement. To further ensure safe delivery of critical public health services, CDC has issued guidance for protecting public health workers engaged in public health activities that require face-to-face interaction.

We appreciate your continued commitment to preventing new HIV infections and ensuring access to critical HIV prevention services as we continue our public health work during this challenging time. This is an evolving situation and CDC will provide additional information as new science and guidance become available. For questions regarding PrEP, please call the PrEPline at 1-855-448-7737.

Sincerely,

/Eugene McCray/
Eugene McCray, MD
Director
Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
www.cdc.gov/hiv

/Jonathan Mermin/
Jonathan H. Mermin, MD, MPH
Rear Admiral and Assistant Surgeon General, USPHS
Director
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
www.cdc.gov/nchhstp