Patients who order PrEP online through a digital health service or telehealth provider may have questions about what to expect in the process. Some patients are comfortable talking to their regular doctor about PrEP medication, but stigma or other barriers to care reduce access for people in rural areas, people who use drugs, or those who are not openly LGBTQ+ their community. In 2021, only 30% of the estimated 1.2 million people who could benefit from PrEP were prescribed it, and only two in five people keep taking PrEP two years after starting. 

In this blog, we detail what patients can expect from the online PrEP care flow, including remote testing for medication maintenance. 

What is at-home diagnostics for PrEP

When patients sign up to receive PrEP online, they will need to perform quarterly testing for HIV, HVB, and creatinine levels as part of medication maintenance. These tests can be performed from home with special collection materials and submitted to a lab for screening. Patients who continue to test negative for HIV and measure adequate creatinine levels can receive ongoing PrEP medication. 

What to expect in a PrEP Kit

Patients who order PrEP online will receive a test kit with collection materials such as DBS cards, lancets, and a specimen bag to mail samples. They can use these materials to self-collect blood samples to submit for lab analysis. 

How to take a PrEP test

There are five steps patients take prior to submitting a sample for testing via the mail. 

1. Open the flap of the dried blood card to expose collection paper, careful not to touch the exposed paper itself. Patients should wash hands in warm water and get their blood flowing with a set of jumping jacks prior to sample collection. 
2. Use an alcohol pad to sterilize the middle or ring finger. Patients then twist the lancet cap off and press the tip near the top of the finger until the needle ejects with a click. It is important for patients to keep their hand below the heart to assist with blood flow. 
3. Apply 3-6 drops of blood to each circle on the dried blood spot card so it soaks all the way through collection paper. Ensure all circles are filled completely, but do not let blood spots run into each other. Patients should not add additional blood to circles that have dried. 
4. Check the back side of the blood collection paper to make sure that the blood has saturated all the way through and filled each circle. Let the paper air dry on a flat surface for one hour, or until completely dry. Repeat the above steps for the second collection card if applicable.
5. Close the blood collection cards and place them into the specimen bag with the desiccant pack. Patients should keep samples out of extreme temperatures (above 100F or below 32F) before shipping.

It is considered best practice for PrEP providers to also screen patients for gonorrhea and chlamydia through 3-site testing. This may include additional collection materials such as urine cups and swabs. In this case, patients are required to submit a self-collected urine sample or swab of the vagina, swab of the mouth, and swab of the anus to determine any infections. Having HIV and another STD may increase the risk of HIV transmission.

How does PrEP work

PrEP greatly reduces a patient’s chances of contracting HIV through sexual contact or injection drug use. It helps produce antibodies, which prevents HIV from replicating in the body. When taken correctly as a once daily pill or shot, PrEP reduces the risk of getting HIV from sex by about 99%. It also reduces the risk from injection drug use by at least 74%. There are two types of pills, Truvada and Descovoy. The shot is called Apretude. 

When a patient is exposed to HIV, the tenofovir and emtricitabine (if the patient uses Truvada) or emtricitabine and tenofovir alafenamide (if the patient uses Descovy) block the enzyme necessary for the virus to replicate. 

Is online PrEP free

PrEP must be free under almost all health insurance plans and state Medicaid programs. There are also state assistance programs to cover the cost of PrEP testing for medication maintenance. Some digital health companies that offer online PrEP also use 340b to cover any additional gaps in funding. 

Conclusion 

Patients interested in PrEP medication can engage in remote care flows that allow them to order online PrEP through digital health companies or telehealth providers. Ash Wellness partners with digital health companies and public health entities to provide PrEP testing services to patients around the country. Schedule a time to chat with our team for more information about STI/HIV and PrEP testing through remote diagnostics.