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Protocol for PrEP (Truvada/DescovyBiktarovy)

What is the protocol for PrEP (Truvada/DescovyBiktarovy)? 

If it is for a new prescription of PrEP remind the patients that before starting the medication they should have a negative HIV test within the last week (while we can offer to order it to Quest, ultimately the patient is responsible for it). If they are otherwise healthy no kidney function test is necessary. If the patient does not have a recent HIV test that is negative, still prescribe the medicine but urge them to get tested within 3 days, and remind them of the risk of resistance if they are taking PrEP while HIV positive (however requiring them to show you the test has been shown to cause a high drop-off rate and therefore the risks outweigh the benefits, as only 1 in every 2400 people starting PrEP had a previously unknown diagnosis of HIV) 

– Counsel them on the risk of other STD’s and that PrEP does not protect them from those, that condoms should still be used, that it will take at least a week for PrEP to reach the level protect them, and the importance of taking it regularly, and that it will take at least a week of taking it before it becomes effective. Also know that PrEP is very expensive if paid by cash and patients should use their insurance; Review the basic facts of PrEP. (https://prepfacts.org/prep/the-questions/ ) 

– refill of PrEP is no issue, just remind the patients to get HIV tested every 3-6 months and get surveillance kidney functions. For HIV/STD testing refer them to our website quick.md/labs if they do not have access to any free testing center and no insurance. 

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