From Evidence to Implementation: Clarifications Around USPSTF Recommendations for HIV Pre-Exposure Prophylaxis (PrEP) - Episode 14
Carl Schmid discusses how the COVID-19 pandemic has amplified health care disparities and accessing HIV PrEP, and Frank J. Palella, MD, comments on the role of telehealth in improving access to PrEP.
Ryan Haumschild, PharmD, MS, MBA: It wouldn’t be a relevant conversation no matter what therapeutic area we’re talking about in our current state if we don’t mention the impact of COVID-19. It’s relevant to everything we do. COVID-19 has changed the way we take care of patients and hopefully you all can entertain me here as we talk through PrEP [pre-exposure prophylaxis] therapy. But Carl, I’m going to ask this one to you. We’ve discussed several groups. You and Sean did an incredible job describing several groups that are impacted, that are less likely to seek PrEP therapy, and some of the unconscious biases, lack of education of who all seeks PrEP therapy but I’m curious from your perspective, Carl. How has COVID-19 amplified these health care disparities and the social determinants? Please speak to that if you would or what you’ve seen thus far.
Carl Schmid: For all the groups, COVID-19 exacerbated and made the situation much worse. First of all, people lost health care coverage. They didn’t go to their medical provider. They didn’t get HIV test, and maybe some of the risk activity went down as well initially during the early periods of COVID-19 but then people started having more sex and it increased. If you look at the STIs [sexually transmitted infections], they have been going up. It’s really a shame that people didn’t take themselves to PrEP because they didn’t go to their doctors. They didn’t go to their providers. But we have adapted to the situation in increasing self-at home HIV testing which you need to initiate PrEP. Also, telePrEP. So yes, it exacerbated the situation, but we’ve also learned to adapt as well, and some of those practices we’re going to continue to use in the future to do more at home HIV testing. Instead of going to a clinic every 3 months or every 6 months to get a HIV test maybe you could do it at home and send it into your clinic. Yes, it’s had a major impact. I hope we’re going to get through it quickly, but we’ve also learned and adapted along the way.
Ryan Haumschild, PharmD, MS, MBA: At home is really translating and one of the things you’ve even mentioned is testing at home, even getting medications. Payors prefer the word courier compared to mail order by getting those high-cost medications to the patient when they needed. It plays a huge role there and it’s also in the way we deliver care and Frank, I’m going to turn to you. What role has telehealth done in changing your practice in the way you’ve been able to provide services to these patients during COVID-19 but even as we move forward and we talk about PrEP in the future, how is it changing the landscape?
Frank J. Palella, MD: Telehealth is a fundamental game changer. COVID-19 has prompted to the evolution of telehealth as a fundamental change in the way we do business, and that telehealth is here to stay. The scenarios in which it can be effective, and practical, and even cost saving are being fully realized as we speak. There is no question that telehealth can provide an effective means to communicate and comprise a component of health care delivery, no question. In terms of PrEP, I’ve had multiple PrEP visits with patients through telehealth. The one thing that obviously we can’t do virtually is certain types of specimen collection that we need to assess the presence of STDs [sexually transmitted diseases] not just HIV, but it is an effective alternative means of communication that can be convenient and which we are now exploring. And we talked about payors a lot here, which we are forging new territory in trying to define and support the justifications with parameters in which payments take the place for telehealth visit, but if your pointed question is, is telehealth being used and effective? Absolutely, yes. Are we going to revert to a pre-COVID-19 strategy? No. Not completely. There’s going to be many circumstances in which telehealth will be preferable particularly for well health visits and in which comprises most people with COVID-19. There are indispensable benefits to seeing people in person. We’re hardwired evolved as human beings to be in the presence of other individuals, and when we’re talking about scenarios of disclosure, and confidence, and overcoming barriers including stigma, including social determinants of health and disparities, in-person visits can be immeasurably valuable to create a sense of confidence and of patient/provider medical intimacy. I’ve spoken long enough, but yes, telehealth is a boom to overall health care including for important preventive HIV and STD health.
Ryan Haumschild, PharmD, MS, MBA: You did a great job describing it.
Transcript Edited for Clarity