PrEP and At-Home Testing

If you're already taking PrEP, you're well aware of the quarterly check up requirement. Your doctor needs to monitor both your HIV status and kidney function to make sure the drug is working as directed. Hopefully your doctor isn't passing up on the chance to check for all those other pesky STIs as well.

PrEP has lead to a dramatic decrease in HIV. It has also dramatically increased the number of patients regularly tested, allowing us to diagnose and treat many other sexually transmitted infections.

If you aren't on PrEP and/or haven't heard of it, we found this excellent site from the San Francisco AIDS Foundation. The CDC also has an exhaustive resource on PrEP, though it's not as beautifully designed.

While PrEP, when taken properly, is unbelievably effective in preventing HIV infections, we still see issues with adherence and discontinuation. Patients struggle to take it daily and schedule follow ups every few months. I, myself, regularly struggle with daily tasks and have never been great at following up with my provider.

Thankfully, we're seeing some really exciting research on the adherence side: monthly shots, augmented PrEP schedules, and SMS reminders to name a few. The need for this research is a reminder that while pill is effective when used properly, the simple act of forgetting to take it can render it moot.

We've seen great research to get patients on PrEP, especially those who lack access or face institutional stigma, predominantly through at-home testing. Both Johns Hopkins and Emory University have pioneered self-collection kits to onboard patients into treatment.

These studies help illuminate the challenges of getting sexual healthcare and on PrEP, but the picture is cloudier when it comes to patients that discontinue PrEP. One undeniable problem is access. There's been a dramatic decreases in PrEP usage since a peak in 2015. Funding cuts, rising deductibles, decreasing coverage, and provider awareness all play a roll.

Another possible explanationand a core hypotheses of Kalamosis that the inconvenience of in-office sample collection is contributing to discontinuation. If you don't live close to a collection location and have a flexible work schedule, it can be a major inconvenience to get tested to stay on the drug.

It's exciting to see a confluence of strategies removing the cognitive load from the patient, but no one will be a silver bullet. The commercialization of these solutions will have huge implications on their adoption and thus subsequent impact.

Our hope is that by partnering with your provider and delivering a sample collection kit directly to your door, we can all but erase this excuse to not continue to monitor your sexual health: just swab, pee, and prick four times a year. Your doctor will be able to advise on any necessary care, the same way he or she already does.

No matter if you're on PrEP or how you're getting tested (because you need to be getting tested at least once a year), I'd be remiss not to remind you of all the other ways to stay sexually healthy. Talk to your partner(s), find condoms that feel great, and use high quality lubes.

If you're worried about your sexual health and don't have a doctor to turn to, this tool from AIDSVu is super handy. If you're an LGBTQ patient and looking for a provider that understands your needs. OutCare has put together an awesome list of providers.

PrEP can be a fantastic drug when taken properly, and access to a sample collection facility shouldn't prevent you from benefiting from it.