Many queer guys in BC can now access PrEP for free via the Centre for Excellence in HIV/AIDS’ Drug Treatment Program (DTP). Getting PrEP through this free program requires enrollment and a prescription from a doctor or nurse practitioner, and also requires some minor (but really important) regular follow up.
Below are all the steps you need to take to get a prescription for PrEP.
Because PrEP is relatively new and the province has only started its public program in 2018, some doctors may not have heard of it, and might not feel comfortable prescribing it. Also, like discussed in “Is PrEP right for me?”, most doctors will only prescribe PrEP if you disclose sexual activity that fits one or more of the ‘high risk’ categories.
Think your health care provider is going to need to be walked through the process? Bring this guidance document to your appointment.
Step 1 – Talk to your Doctor
Talk to your doctor or nurse practitioner about PrEP and why you are interested in it. This might require sharing some pretty personal information, and we know that can be a barrier to many of us when talking to their primary healthcare provider not just about PrEP, but sexual health in general.
Your doctor or nurse practitioner will confirm your eligibility for BC’s PrEP program using this eligibility and baseline assessment form.
If you do not currently meet the ‘HIV risk’ eligibility requirements to be on PrEP, you may want to explain to your healthcare provider that you may meet the qualification in the future and that you want to be PrEPared when you do.
Healthcare providers have more discretion than you may think in being able to enroll you in the public PrEP program if they think you will engage in activities that will make you eligible in the future.
Your nurse or health practitioner will then give you a lab requisition form for you to take to a lab where you will have tests done (described in Step 2).
If you’re not comfortable sharing details about your sex life with your primary care provider, you may want to find a way a prescriber to pathway to PrEP using checkyourself.today.
You can also contact HIM and we can try to help connect you with a gay-friendly provider, or with providers here in Vancouver who might be more familiar with PrEP, and more willing to work with you to consider it as an HIV prevention strategy for you. Remember that the most important thing here is that you have to have a prescription for PrEP, and it does require some follow up, so having a regular provider is essential.
Step 2 – The Tests
Once you and your healthcare provider decide PrEP is a good choice for you, they’re going to need to have to complete some really important tests. These tests are listed below, and you should make sure you know about them, just in case your doctor isn’t familiar with all the steps to prescribing PrEP. Here is the printable fact sheet that has some helpful hints on talking to your provider about PrEP, and a brief list of all the required tests you need before and after starting PrEP- just in case they aren’t familiar with PrEP, and aren’t sure what tests you need.
Your doctor or nurse practitioner will receive the results of your tests directly.
Before Starting PrEP: The Tests
- HIV: It’s essential you get an HIV test before you start PrEP. If you start PrEP and are positive but don’t know it, it can be a big issue. Even though Truvada is used as an HIV treatment drug, on its own it isn’t powerful enough to control the virus. This means if you’re taking PrEP but are HIV positive and don’t know it, the virus could mutate and become resistant to Truvada. Because Truvada is considered a ‘frontline’ medication for HIV treatment (because it’s so safe and well-tolerated), it’s important that it is only reserved for proper use in combination with other drugs for HIV treatment and prevention. After you take your HIV test, your provider will likely recommend that you avoid any sexual activity that can pass HIV for about seven days after you start Truvada for PrEP. This is just to make sure you have enough medication in your bloodstream to prevent you from getting HIV before you have sex.
- Hepatitis B: Truvada can also cause complications for people who have Hepatitis B, even if they don’t know it. It can also cause complications for people who contract Hep B after they start PrEP. So, another essential test is a Hep B test if you haven’t been vaccinated, or what’s called a ‘titer reading’ if you have been vaccinated. A titer reading tells your provider how active your vaccination is, and will help them determine if you should be re-vaccinated. If you haven’t been vaccinated against Hep B., you will need to be before you can start PrEP.
- Kidney function test: because a very small number of people will have decreased kidney function as a side effect of PrEP, your provider should test your kidney function before you start PrEP, and also one month after. This will let you and your provider know if it’s safe to start, and will also let you both know very quickly if any kidney issues arise. The specific test your doctor should ask for will measure (or estimate) how efficiently your kidneys clear a kind of protein called ‘creatinine.’
- STI tests: STI screening is also part of initiating PrEP, both when you start and for however long you take the medication. REMEMBER: PrEP DOES NOT PREVENT ANY OTHER STIs! For many reasons, you should get tested every three months. One great thing about PrEP is STI testing becomes a more regular part of your overall healthcare regimen!
While You’re on PrEP: The Tests
- HIV: even though you’re taking PrEP to prevent HIV transmission, you’ll still need to get tested for HIV every three months. Because PrEP is still pretty new, researchers are following users closely to make sure it’s as effective as studies indicate. We also know that all HIV prevention methods, including condoms and PrEP, will not work 100% of the time. Getting tested for HIV every three months ensures that in cases where PrEP didn’t work to prevent HIV transmission, people can get the treatment they need immediately.
- STI tests: Because researchers have established that some (though not most) people might change how they use condoms after they start PrEP, you’ll need to get tested for all STIs every three months, even if you’re still using condoms. These are part of the guidelines established by Health Canada, so remember to ask for these tests if your health care provider overlooks them. As we have noted before, STI rates in Vancouver are high, and some, like syphilis, are now considered outbreaks. It’s important to get your STI tests for your PrEP regimen, but all people should be getting tested a lot more frequently, and taking more steps to prevent themselves and others from STI transmission through safer sex methods.
- Kidney function test: just like we talked about above, PrEP can impact kidney function for a small number of people. Usually this happens pretty soon after you start the medication, but it can also develop later on, so your provider should be making sure you have your kidney function / creatinine clearance tested every three months as well.
Step 3 – Enrollment, Getting a Prescription, and then PrEP
Once your doctor or nurse practitioner receives and confirms your test results, they will likely request another appointment to complete the enrolment process. This will involve filling out these enrolment forms and faxing them to the BC Centre for Excellence at the number listed on the documents. Faxes are processed in approximately three working days.
You will need to pick up your prescription at St. Paul’s Hospital pharmacy. If you live outside of Greater Vancouver, St. Paul’s Hospital pharmacy can mail you your prescription at certain local pharmacies. You can ask your doctor or nurse practitioner to help you set this up.
Please note that your first prescription will supply you with 30 days’ worth of PrEP. All subsequent prescriptions will be for three months.
Step 4 – PrEP Refill
When it’s time to refill your prescription, you will need to do another series of tests (described above) to ensure that you’re not experiencing damaging side-effects. Have your doctor or nurse give you this requisition at your previous appointment, if you can! Otherwise you’ll have to visit your health care provider again before going to the lab for this series of tests.
Your health care provider will then fax a PrEP refill form to the BC Centre for Excellence. You will then need to call the St. Paul’s Hospital pharmacy to confirm your PrEP order. Once you do, St. Paul’s Hospital pharmacy will ready your three-month supply of PrEP for you. Allow three work days for pick-up and five work days for delivery.