Transcript Empower U, CHC, PrEP Implementation in an

PrEParation:
An FQHC’s guide to PrEP implementation
Joey Wynn,
Community Relations Director
Empower U – FQHC
November 9th, 2016
Miami, FL 33147
Agency Background:
Empower U was founded in 1999 as a 501(c)3 nonprofit organization. In
2014, EU became an FQHC. Originally started to provide HIV services such as
C & T and outreach, case management & Ryan White funded activities to the
general population in the Liberty City area.
EU quickly grew to specialize in provision of HIV prevention education, social
services and mental health for HIV to men and women living with the
disease. Several programs were introduced to specialize in care for gay,
bisexual, and other men who have sex with men.
In the past 2 years, EUCHC has expanded to provide comprehensive medical
services to the entire community, and established programs for Transgender
women of color (Trans Illuminati) and Pediatric vaccination & Immunization
programs for the local communities.
Terminology
Reference Guide
PrEP
Pre-exposure
prophylaxis
PEP
Post-exposure
prophylaxis
TasP
Treatment as
prevention
TAsP
PrEP Candidates
Who?
Discordant Couples
Individuals with recent diagnoses of an STI
Individuals who frequent high-risk venues
Having unprotected sex in Miami Dade County
PrEP Care Team
Provider
Clinic staff
Eligibility
HIV testing staff
Patient Educators
PrEP Education Strategy
Internal:
Team meetings
Staff PrEP Rallies
Provider Champions
External:
Community Forums
Focus Groups
Community Health Workers
PrEP “Down It” Marketing Campaign
Access Points?
Internal Providers
HIV testing staff referrals
Community referrals
Walk-ins (Marketing)
PrEP Media Strategy & Marketing
PrEP Workflow
Patient Navigators:
Education session occurs with Patient
Navigator, regardless of point of entry
Patient Navigators schedule Eligibility and
PrEP labs
Labs are ready for 1st Provider PrEP visit
PrEP Access
Medication Access:
Lab and clinic visit costs are covered through the
normal eligibility process
ACA and Private Insurance companies are covering
PrEP; some require a denial first, then an appeal,
but ultimately they cover it.
FL Medicaid Managed care Plans must cover PrEP
Gilead PrEP Medication Assistance Program
provides only a 90-day supply. Labs must be done
before next provision of medication, payor of last
resort for this
PrEP Workflow
Initial Provider Visit:
Provider discusses lab results, PrEP protocol
and patient readiness (agreement form).
EU’s 340b Specialty Pharmacy provider helps
uninsured patients apply for Gilead’s PrEP
Patient Medication Program behind the
scenes, or paperwork for Industry co pay cards,
other required documentation for Insurance
programs, etc….
PrEP Documentation
ICD-10 code utilized for PrEP
Z41.8 “Encounter for other procedures for
purposes other than remedying health state”
Z79 “Long Term drug use for Prophylactic
Purposes”
Electronic Health Records “Enabling Service Form”
Internal PrEP database
January 2016
avac.org/infographic
ARV-Based Prevention Pipeline
PRE-CLINICAL
PHASE I
PHASE IV
PHASE III
PHASE II
R
IPM
Pop Council
IPM
IPM
CHAARM
IPCP NIAID
IPM
IPM
TaiMed
IPM
CONRAD
CONRAD
GSK/ViiV
Janssen
R
IPM
ImQuest
ACTIVE DRUG
Pop Council
CHAARM
CONRAD
ImQuest
Albert Einstein
IPM
IPM
RTI
TFV
Tenofovir
DAR Darunavir
TFV
Tenofovir
prodrug
DAP Dapivirine
TDF
Tenofovir disoproxil
fumarate
GRF Griffithsin
Vaginal tablet
TFV/
FTC
Tenofovir/
emtricitabine
Rectal gel
TDF/
FTC
Tenofovir disoproxil
fumarate/emtricitabine IQP IQP-0528
MIV
150
MIV 150
5P12 5P12-RANTES
TMC
278
Ripilvirine
744
MVA
Maraviroc
MAb Monoclonal antibody
RAL
Raltegravir
No drug tested
currently
DELIVERY SYSTEM
Oral pills
IPM
Vaginal gel
PBS
Pop Council
CONRAD
Pop Council
R
CDC
Gilead
IPM
HPTN/ACTG CONRAD
Mintaka
Vaginal ring
Vaginal film
Pop Council
PBS
Phosphate
buffered saline
R
Long acting
injectable
Thin film
polymer
Nano-fiber
DS003 DS003 (BMS793)
GSK 744
GSK744 Long Acting Is Formulated as a 200 mg/mL Nanosuspension
GSK1265744 (GSK744)
F
O
N
H
F
H
N
O
N
O
OH O
Dolutegravir
F
O
N
H
F
H
N
O
N
O
OH O
1. Müller et al. Eur J Pharm Biopharm. 2011;78:1-9. 2. Spreen et al. IAS 2013; Kuala Lumpur, Malaysia. Abstract WEAB0103.3. Min et al. ICAAC
2009; San Francisco, CA. Abstract H-1228. 4. Taoda et al. International Congress on Drug Therapy in HIV Infection 2012; Glasgow, Scotland.
Abstract P206.
Andrews et al. CROI 2014; Boston, MA. Abstract 39.
Pharmacokinetic Evaluation of a Single Intramuscular GSK744 LA
Injection in Human Volunteers
Plasma GSK744 (µg/mL)
10
200 mg
400 mg
800 mg
4X PAIC90
1
1X PAIC90
0.10
0.01
0
4
8 12 16 20 24 28 32 36 40 44 48 52
Time (weeks)
Andrews et al. CROI 2014; Boston, MA. Abstract 39.
Adapted from Spreen
et al. IAC 2012;
Washington, DC.
Abstract TUPE040.
CROI Updates are promising!
PrEP: Lessons Learned
Preparation is key! Think through logistics carefully
Keep in mind PrEP points of entry
Providers must be familiar with PrEP protocol and necessary
follow-up appointments
Provider PrEP champion helps with “buy-in”
Rapport between Patient and Patient Navigator is vital
Eligibility specialist /Pharmacy skilled in medication program
Prepare for how to properly document in patient’s medical
record if working in a EHRS
THANK YOU!!!
Questions?
I can be reached for further information about these
materials at [email protected]