Give This to Your Doctor When Talking about Pre-exposure

Prophylaxis (PrEP)

Quick-start Guide for Medical Providers

on HIV Pre-exposure Prophylaxis

PrEP Your Provider

1. Prevent HIV OK: PrEP Your Provider http://PreventHIVOK.org/PrEP-Your-Provider2. CDC PrEP Basics http://www.cdc.gov/hiv/basics/prep.html3. CDC Pre-Exposure Prophylaxis Research http://www.cdc.gov/hiv/prevention/research/prep/4. CDC PrEP Fact Sheet for Providers http://www.cdc.gov/hiv/pdf/PrEP_fact_sheet_final.pdf5. Gilead Sciences PrEP Website https://start.truvada.com6. Guidance for Use of PrEP to Prevent HIV http://www.hivguidelines.org/clinical-guidelines/pre-exposure-prophylaxis/guidance-for-the-use-of-pre-exposure-prophylaxis-prep-to-prevent-hiv-transmission/7. San Francisco AIDS Foundation PrEP Facts http://prepfacts.org/assets/PrEP_Facts_16-pager_brochure_mech_FINAL.pdf

PrEPLine: +1-855-448-7737 (toll-free) Provides expert guidance to clinicians

about prescribing PrEP

Local provider information Avery 5160 Label

Other Benefits

Resources

Consultation

Good news! You have a patient who wants to take better control of their health and begin a PrEP regimen.

If you aren’t familiar with PrEP or could use more information, this brochure will go over some basic information for providers.

It includes information, such as:

• pre-prescription lab work• summary of guidance for PrEP use• ICD-9, ICD-10, and CPT billing codes

• PrEP stands for pre-exposure prophylaxis• PrEP is a pill that patients can take daily to help prevent HIV infection• Truvada is the only FDA-approved (2012) drug for use as PrEP• PrEP reduces the risk of HIV infection from sex by over 90%

Quick Facts

A pre-exposure prophylaxis regimen affords you the opportunity to see your patient every 3 months.

These visits allow you to discuss sexual health and harm reduction strategies to prevent the contraction of other sexually transmittable infections.

These quarterly visits also allow you to administer general health screenings, monitor patient health progress, and perform other health maintenance functions.

Billing CodesCurrently, there are no official ICD-9 or ICD-10 codes for PrEP. These were compiled from medical providers who are prescribing PrEP.

CPT Code Description99401 Preventive counseling (15 min)99402 Preventive counseling (30 min)99403 Preventive counseling (45 min)99404 Preventive counseling (60 min)

ICD-9 ICD-10 Description (ICD-10)V74.5 Z11.3 Encounter for screening for STIV73.89 Z11.4 Encounter for screening for HIVV01.6 Z20.2 Contact with and exposure to STIV01.79 Z20.6 Contact with and exposure to HIV

V58.83 Z51.81 Encounter for therapeutic drug monitoring

V58.89 Z51.89 Encounter for other specified aftercareV69.2 Z72.51 High-risk heterosexual behaviorV69.2 Z72.52 High-risk homosexual behaviorV69.2 Z72.53 High-risk bisexual behaviorV58.69 Z79.899 Other long term (current) drug therapy

PrEP can cause side effects like nausea in some people, but these generally subside.

Common side effects include:• abdominal pain,• decreased weight,• headache, and• dizziness.

Review prescribing information for details.

Side Effects

Men Who Have Sex with Men Heterosexual Women & Men Persons Who Inject Drugs

Detecting High-risk Behavior

• Sex partner with HIV• Recent bacterial STI• Many sex partners• History of inconsistent or

no condom use• Commercial sex work

• Sex partner with HIV• Recent bacterial STI• Many sex partners• History of inconsistent or

no condom use• Commercial sex work• Lives in a high-prevalance

area or network

• Injecting partner with HIV• Shares injection equipment• Recent drug treatment (but

currently injecting)

Clinically Eligible

• Documented negative HIV test before prescribing PrEP• No signs/symptoms of acute HIV infection• Normal renal function, no contraindicated medications• Documented hepatitis B virus infection and vaccination status

Prescription Daily, continuing, oral doses of TDF/FTC (Truvada), ≤90 day supply

Other Services

• Follow-up visits once every 3 months (≤90 days) to provide: Rapid HIV test, medication adherence counseling, behavioral risk reduction support, side effect assessment, STI symptom assessment, other health assessments

• At 3-months and every other 6-months: Assess renal function• Every 6 months: Test for all other STIs

• Perform oral and/or rectal STI testing

• Assess pregnancy intent• Pregnancy test every

3-months (if applicable)

• Access to clean needles/ syringes and drug treatment services

The following table outlines the CDC’s summary of guidance for PrEP use. It is important that the guidelines are followed and applied carefully and consistently to all patients seeking to begin a PrEP regimen. Deviation from these guidelines is very strongly discouraged.

Summary of Guidance for PrEP Use F Baseline HIV Test• For most patients: Obtain a 4th (recommended)

or 3rd generation rapid HIV test• For patients with symptoms of acute HIV

infection or who report having unprotected sex with a person living with HIV in the last month: Perform nucleic acid amplification test (NAAT, viral load) for HIV

 F Basic Metabolic Panel• Do not initiate PrEP in patients with creatinine

clearance <60 mL/min

 F Urinalysis• Proteinuria is an early warning sign of tenofovir

toxicity; baseline urinalysis is needed to identify pre-existing proteinuria

 F Serology for Viral Hepatitis A, B, & C• Immunize against hepatitis A & B in non-

immune patients

 F Screening for STIs• NAAT for gonococcal & chlamydial infection—

test exposure site (genital, rectal, pharyngeal)• Rapid plasma reagin (RPR) for syphilis

 F Pregnancy Test (if applicable)• Discuss the risks & benefits if a patient is

pregnant when starting PrEP or becomes pregnant while on PrEP

Initial Lab Work