UCSF gets CDC grant to provide expert guidance to clinicians who prescribe anti-HIV medications

The UCSF Clinician Consultation Center at San Francisco General Hospital and Trauma Center has been funded by the Centers for Disease Control and Prevention (CDC) to provide a PrEPline, a telephone consultation service that gives expert guidance to healthcare providers across the nation who prescribe antiretroviral medications to HIV uninfected individuals to prevent HIV.

The intervention, commonly known as PrEP (pre-exposure prophylaxis) involves the daily use of an existing anti-HIV medication—a single pill, two-drug combination of tenofovir and emtricitabine—to prevent HIV infection in adults at high risk. The Food and Drug Administration approved the new indication in 2012, and earlier this year, the U.S. Public Health Service issued the first comprehensive clinical guidelines for PrEP.

"Many of the clinicians prescribing PrEP will have had limited experience prescribing antiretroviral drugs. We will be guiding these clinicians throughout the country as they work through decisions about who might benefit from PrEP as well as who is not appropriate for receiving PrEP, including helping with identifying patients' risk," said the Center's director, Ron Goldschmidt, MD, UCSF professor of family and community medicine at San Francisco General Hospital and Trauma Center (SFGH).

"In addition, we will be assisting clinicians in evaluating patients' ability to take PrEP regularly since missed doses can negate the benefits of PrEP. We'll also be reminding clinicians to encourage other standard prevention methods, like using condoms, along with PrEP."

The Centers for Disease Control and Prevention has awarded $175,000 dollars in the first year of the grant to the UCSF Clinician Consultation Center at SFGH, which will run the phone-based consultation service for clinicians with questions about PrEP.

"We also will be advising healthcare providers on how to give PrEP safely when it's indicated. Individuals on PrEP need an HIV test to make sure they are uninfected before starting. Otherwise drug resistance could emerge in those with a pre-existing HIV infection. And in a small percentage of patients, some side effects could be serious, so testing to monitor potential side effects as well as other sexually transmitted infections is an important part of safely giving PrEP. We'll also provide guidance on stopping PrEP safely when it's time to stop," added Goldschmidt.

So far, use of PrEP by individuals at risk of becoming infected with HIV has risen slowly following FDA approval. The manufacturer of the only medication approved for PrEP to date estimated that only 1,774 prescriptions of the drug were filled for this indication through May of 2013.

"We think that while the use of PrEP by individuals at high risk for HIV is accelerating, it has been hampered by barriers to access. One significant barrier reported by many community members has been difficulties in getting their clinicians to prescribe PrEP when they've asked for it. A major reason is many caregivers' lack of knowledge about and experience in prescribing PrEP. People who are not HIV positive are seen by variety of providers including primary care doctors and ob/gyns. The new PrEP Warmline by the Clinician Consultation Center addresses a large unmet need and will be a tremendous resource to help doctors safely prescribe medications that many patients need to avoid HIV infection," said Dana Van Gorder, executive director of Project Inform, one of the nation's leading HIV/AIDS advocacy agencies.