Tamsy “TAM” @tamlovestoeat and Dr. Charlotte-Paige Rolle Talk PrEP Options

[00:00:00]What prep options are available today?

[00:00:02]And how can someone choose between like a daily pill or a long acting injection?

[00:00:07][music] [bell] What prep options are available today?

[00:00:13]And how can someone choose between like a daily pill or a long acting injection?

[00:00:18]>> Yeah, Tamzy. I mean it really again I think about where we've come in the field and it really honestly is an honor to practice today because you know we have so many options for for our patients and and we know that when we can provide patients with more options that better meet their individualized needs and their lifestyle and preferences. We know that that translates directly into, you know, better clinical outcomes and in the case of prep, better prevention outcomes, right? And so whether you're a daily pill popper and you feel comfortable with incorporating that into your routine, you know, we have daily pills.

[00:00:54]Whether the thought of taking a daily pill makes you want to gag and you're like, "Well, Dr. Roy, I don't take any other pill. Like, how am I going to manage to take a daily pill to prevent HIV?" Guess what, Tamzy? We have injectable options. You call them long acting options. injectable options uh for HIV prevention. You know, we have an every two-month injectable and then we also have Tamzy an every six month injectable. Think about what that means.

[00:01:19]A twice a year injectable to prevent HIV, right? And so we really have a popery of options available today to really, you know, meet anyone's needs.

[00:01:29]uh you know hopefully uh people can uh feel empowered to pick the option that best best fits with their with their lifestyle and work with their health care provider to obtain access to whatever option they feel may be best uh for them. Um and we have some great healthcare providers throughout the country that really know a lot about these options and and have the ability to serve a lot of communities uh regardless of where you are in the in North America. Do racial disparities in prep uh access exist and what what is the potential impact on HIV epidemic?

[00:02:08]>> Yeah, you know, this is a question that kind of keep me up at night sometimes, Tamzy. Um you know, as a researcher, uh disparities in access to care are very uh near and dear to my heart. And we uh certainly have racial disparities in prep that unfortunately uh mirror the racial disparities we see in HIV in terms of new infections, right? And so our black and brown communities um they they tend to have the least access to prep. Um they have the lowest rates of prep uptake and prep use in North America and that has been persistent ever since the FDA approval of PREP in 2012. And you know, we could even we could talk for, you know, honestly, I could talk for 60 minutes on the reasons like why that is, right? Racism, stigma, homophobia, all the things that predominate more so in communities of color, you know, um, uh, inadequate access to health care, uh, uninsurance or under insurance, right? Some of us, many of us live in states that did not expand Medicaid, for instance, right?

[00:03:11]And so, uh, a lot of folks from communities of color are left with with no real, uh, private insurance or even even public insurance, uh, to feel like they can access prep. There's so many reasons why why that occurs, Tamzy. And, you know, the problem with that is that these are the communities that have the highest rates of new HIV infection, and we're not getting prep to those people, right? We have PrEP. It's an amazing tool, but we've seen greater uptick in white communities that also have the lowest rates of new infection. And so I do not expect any of us to be mathematicians and statistitians, but we can imagine a situation in which we don't have prep getting to where it needs to go. We actually have the ability to even see more disparities, right? Uh in terms of new HIV infections if we're not getting prep to the communities who need it the most. And that really has the ability, the unfortunate ability Tamzy, to really worsen the gaps when we talking about ending the HIV epidemic if we can't get these interventions to the communities that are most in need.

[00:04:18]>> Okay. So, how accessible is PREP for individuals without ins insurance and in lowincome situations?

[00:04:24]>> Yeah, you know, Tom, this really depends on where you live. We talked about location matters and and geography matters as well because there are really a a couple of ways and it it some of these mechanisms are more robust in certain states, right? And so for the most part, the easy answer is whatever is your public health department, okay?

[00:04:43]Like most public health departments do have some sort of prep program uh for under or uninsured uh clients, okay? But as you may know, it's kind of hard to navigate a lot of state and local health departments. You know, these are systems that are often very overwhelmed, heavy case burden, a lot of patients, potentially long wait times to get in.

[00:05:06]So, some states have taken it a step further, Tamzy, and there are state prep assistance programs. New York is a example of a state that I can give you that has a prep assistance program, right? and that operates like kind of sort of in conjunction with the health department but has a separate funding mechanism and so through that mechanism we can get more under or uninsured people on prep. The manufacturers of the drugs that we use for prep have very robust assistance programs to often provide the drug completely free of charge to anyone who actually completes the application. And I'm even talking about for the injectables Tamzy. So don't think that the injectables cannot uh be provided free of charge for underinsured or uninsured patients. They absolutely can. But then Tamzy, if someone's under or uninsured and they can get the medication, what about the prescription? What about the labs? What about the doctor's visits that are still required, right? And so we we unfortunately still have that gap for our uninsured or underinsured patients that, you know, for whatever reason don't want to use the services provided by their local health department. Um, you know, a lot of the community uh health centers, the federally qualified health centers, they do have prep uh uh sliding scale programs, right? Based on income, they may charge you a um minimal visit for a visit cost. They may have labs that they offer at reduced pricing.

[00:06:29]We have that here uh where I work at the Orlando Immunology Center. But Tamsy, it certainly really depends on where you are whether some sort of program like that may be available to you.

[00:06:39]>> Okay. Well, I really enjoy this conversation. Thank you, Dr. Ro, for sharing so much valuable information that's helping educate both me and my community on the importance of HIV prevention.

[00:06:52]>> Awesome. Thanks for having me, Tamzy.

[00:06:54]>> Yes.