The unknown impact of prescribing PrEP out of a practice is a commonly reported barrier to beginning to prescribe the HIV prevention medication.
NZAF spoke to Dr Torrance Merkle of Hobsonville Family Doctors about how PrEP prescription has been effectively implemented in their practice.
“I’ve found that my PrEP patients are actually willing to do a lot of the initial work themselves. They tend to be relatively informed about PrEP and get the hang of making sure they are booked in for review 1-2 weeks before they run out. For first consults, I use a typing template, so I know we’ve discussed and documented everything.
“We did some brief education with our nurses so they knew there would be a slight increase in testing needs and why – this way they’re informed and know the deal. It just becomes a part of the routine. Our nurses are also more confident doing sexual health checks for MSM, if needed in between their PrEP visits.
“Our clinic has found the most efficient way of doing PrEP repeats is for the patient to book in 1-2 weeks before their script is due, so they don’t run out. In the consult the Doctor can do the throat swab and supply the urine test and rectal swabs for the patient to do next. We then offer for the nurse to do their blood test (for a fee) to save them having to travel and wait at the lab. I usually text results through within a day or two, along with confirmation that I’ve renewed the special authority.
“I’d say that prescribing PrEP is actually simpler than many other presentations we see as GPs – although there are a few risks and things to monitor, there are huge benefits to individual patients and the community in terms of preventing HIV transmission. If prescribing several patients this medication prevents even a single case of HIV acquisition, then we’re doing our job.
“A comparison could be drawn with the combined contraceptive pill – it just requires a discussion of risks and benefits to the patient, and making sure they understand enough to make an informed decision. Although there tends to only be one consultation per year for the pill, there are usually only four check-ins with PrEP patients which can definitely be managed.”
“I’ve found that offering PrEP has been really rewarding, as you get to know patients really well when you meet them every three months!”