Are you PrEP(ared)? PrEP Basics & Knowledge Dissemination

Transcription

1 Are you PrEP(ared)? PrEP Basics & Knowledge Dissemination Harlan Pruden Educator, Chee Mamuk, Aboriginal Program BC Center for Disease Control, Clinical Prevention Services Sḵwx on the traditional, ancestral and unceeded territory of the wú7mesh Úxwumixw, Tsleil-Waututh and xwməθkwəy əm First Nations UBC Learning Circle's Centre for Excellence in Indigenous Health Presentation 13, February, 2018

2 Disclosures As of February 2018, I have no conflicts of interest to declare. 2

3 Objectives: Discussion from a First Nations and Inuit People lens: What is PrEP? Who is PrEP for? Accessing publicly-funded PrEP in BC and in Canada Resources 3

4 Chee Mamuk Team: Felicia Tebb Ojibwe Administrative & Community Support Jessica Chenery Penelakut Program Lead Michael McCarthy Yuʔłuʔiłʔath Educator Lynette La Fontaine Metis Nurse Educator Harlan Pruden Cree Educator Amanda Porter St uxtews Nurse Educator (on maternity leave) 4

5 Chee Mamuk provides innovative and culturally appropriate HIV, Hepatitis and STI education, resources and wise practice models for and with Aboriginal communities. This is accomplished by the following: o Around the Kitchen Table o Encouraging Strong Paths o Two-Spirit Program o Creating Community Relevant Resources 5

6 6 The Chee Mamuk tree serves as our theoretical understanding. The post-its, on our tree provide a visual road map to guide our current work load.

7 The HIV Combination Prevention Toolbox Post-Exposure Prophylaxis (PEP) Pre-Exposure Prophylaxis (PrEP) Prevention of Motherto-Child Transmission (PMTCT) Vaccines HIV Prevention Toolbox Medical Treatment as Prevention (TasP) Microbicides Sexually Transmitted Infections (STIs) Diagnosis and Treatment Clean Syringes (Needle Exchange Programs) Condoms and Other Barrier Methods Behavioral/Physical Barriers Harm Reduction Education Treatment/ Prevention of Drug/ Alcohol Abuse 7

8 Comprehensive HIV prevention includes multiple approaches instead of just one or two approaches. 8

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10 No one HIV prevention approach will be acceptable to all people. Research is critical to develop and test new prevention options that offer people more choices. The best option for one person may not be the best for others. 10

11 npep vs. PrEP PrEP: treatment before exposure HIV Exposure PEP: treatment after exposure 11

12 Post-Exposure Prophylaxis (PEP) Pre-Exposure Prophylaxis (PrEP) Prevention of Motherto-Child Transmission (PMTCT) Vaccines HIV Prevention Toolbox Medical Treatment as Prevention (TasP) Microbicides Sexually Transmitted Infections (STIs) Diagnosis and Treatment Clean Syringes (Needle Exchange Programs) Condoms and Other Barrier Methods Behavioral/Physical Barriers Harm Reduction Education Treatment/ Prevention of Drug/ Alcohol Abuse 12

13 The PrEP prevention approach is focused on people who do not have HIV, but may be at risk of exposure to HIV through sexual contact and/or injection drug use (IDU) With PrEP, people who do not have HIV receive a prescription for a medication. The medication is a pill, taken once again a day. The medication may lower their risk of HIV transmission if they are exposed to HIV. 13

14 PrEP Progress in Canada Ø Ø Ø Ø Ø In 2006, the co-formulation of emtricitabine/tenofovir (trade name: Truvada) received its Notice of Compliance (NOC) from Health Canada for the treatment of HIV-1 infection. In 2007, Truvada listed as a Non-Insured Health Benefits (NIHB) benefit for treatment of HIV-1 infection. The NIHB provides coverage to eligible residents of Canada who are either: a First Nations person who is registered under the Indian Act; an Inuk recognized by an Inuit land claim organization; or an infant less than 1 year old whose parent is a registered First Nations person or a recognized Inuk. In BC, the First Nations Health Authority (FNHA) began receiving transfer payments from Health Canada for the NIHB program on July 2, Truvada, as a treatment, was covered by FNHA. Feb. 6, 2016 Health Canada issued an NOC for Truvada, in combination with safer sex practices, for the preventive indication of pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 infection in HIV-negative adults at risk. FNHA followed Health Canada and began to cover PrEP. 14

15 HIV Prevention Using Truvada Truvada is a combination of two antiretroviral drugs: Tenofovir disoproxil fumarate (also called TDF, or tenofovir) Emtricitabine (also called FTC) Truvada is approved for daily use for HIV prevention. Truvada must be taken on a consistent, daily basis to be effective as PrEP. PrEP is NOT effective in preventing other STBBI including: syphilis, gonorrhea or hepatitis It is recommended that people who are prescribed PrEP and to be used as a combination prevention strategy that includes behavioural interventions and other strategies from the medicine wheel. 15

16 HIV Prevention Using Truvada, continued How Truvada as PrEP works Truvada is an antiretroviral medication (ARV) that protects HIV-negative people from acquiring HIV if they are exposed to the virus ARVs block the action of a protein that HIV needs to infect the body 16

17 HIV Prevention Using Truvada, continued Who should use Truvada for HIV prevention? Male-assigned Two-Spirit and/or Native men who have sex with men Transgender women who have sex with men Heterosexual couples where one partner has HIV and the other does not People Who Inject Drugs (PWID) 17

18 Accessing Truvada, here in BC Requirements for use Be HIV negative proven by testing prior to starting use (4th generation HIV Ag/Ab test) Other baseline bloodwork is required: Hepatitis B surface antigen (HBsAg), creatinine, and estimated glomerular filtration rate (egfr) Ongoing testing for HIV infection at least every 3 months while taking Truvada 18

19 Accessing Truvada, here in BC First Nations & Inuit People in BC and the rest of Canada 1st appointment/visit: Baseline bloodwork 2nd appointment/visit: Based on a review of baseline bloodwork, Truvada prescribed 3rd appointment/visit: Prescription is filled at no coast at any pharmacy. 19

20 Accessing Truvada, here in BC General Population including Metis People in BC (Non-Inuit & First Nations People) 1st appointment/visit: PrEP is requested and baseline bloodwork ordered 2nd appointment/visit: Based on a review of baseline bloodwork, prescriber completes CfE form and submitted for approval (up to 2 business days). PrEP medication is prescribed. 3 rd appointment/visit: PrEP prescription is filled at St Paul's Hospital Ambulatory Pharmacy Burrard Street, Vancouver Outside of Vancouver 3 rd appointment/visit: Prescriber arranges for PrEP prescription to be filled at St. Paul s and sent to their office for dispensing 20

21 PrEP Summary PrEP is a medical prevention approach for people who do not have HIV but are at risk for HIV infection. They take a specific medication on a daily basis to reduce the risk of HIV infection if exposed through sexual contact and/or intravenous drug use. 21

22 PrEP Summary continued: 22

23 For More Information SOCIAL MEDIA AND ONLINE COMMUNITIES: PrEP Canada: Rethinking HIV Prevention - PrEP Facts: Rethinking HIV Prevention and Sex OTHER RESOURCES: BC Centre for Disease Control s SmartSexResource.com search PrEP for more information BC Centre for Excellence in HIV/AIDS HIV Drug Treatment program information CATIE.ca Pre-exposure prophylaxis (PrEP) GETPrEPED PrEP information website for BC from the Health Initiative for Men The Sex You Want PrEP information for gay and bisexual men (Torontobased) US Centres for Disease Control and Prevention Pre-exposure prophylaxis (PrEP) 23

24 Discussion and Questions? And Thank You So Much! 24