Maintaining PrEP Adherence During a Pandemic

While the world was consumed by the COVID-19 pandemic, Giffin Daughtridge got some much-needed good news. The Harvard University-based start-up the doctor cofounded, UrSure Inc., was purchased in late May by HIV testing company OraSureTechnologies. UrSure initially found success with its development of urine tests that detect adherence levels for people on pre-exposure prophylaxis, or PrEP. Much less invasive than previous adherence tests, UrSure’s tools help ensure people at high risk of seroconverting remain HIV-negative. 

Daughtridge recently spoke to Plus about the challenges to PrEP adherence, especially during the pandemic, and spoke of the complications attached to an injectable version of PrEP.

Plus: What do you see as the biggest challenges to PrEP adherence now?
Daughtridge: The framework for PrEP’s success is really a three-legged stool—you need uptake, adherence, and retention. COVID is threatening all three. People are struggling with uptake because people are having less in-person doctor’s visits to see if they’re good candidates for PrEP. They’re not having the ability to talk to providers about barriers to adherence. When you can’t go out to the pharmacy, refilling that prescription is more difficult. There are employment issues, health insurance issues; hoops to jump through when you don’t have insurance.

Is telemedicine a solution?
There definitely are great tools with telemedicine. The issue is it doesn’t seem to be enough. There’s been a huge drop-off in the number of PrEP prescriptions getting filled, both new starts and recurring prescriptions. Are the people going to come back [after COVID] or have we lost those people indefinitely?

A recent study of an injectable version of PrEP found it more effective than the pill version. Will this solve many adherence issues?
Any time we can expand the number of options in the PrEP tool kit, it’s great. Where we may be missing the mark is when it’s described as a panacea for adherence issues. One of the great things about oral PrEP is similar to contraception; you have a lot of flexibility. You can come on and off of it. That’s not as possible with an injectable because you have the 48-week tail. If you don’t keep re-upping the injection, you’ll have some amount of that drug in your system, but it won’t be enough to prevent HIV— however, it could be enough to cause viral resistance if you were to seroconvert.

Could PrEP ever be available over the counter?
There have been states that have tried different things like pharmacy-prescribed PrEP.  I can’t imagine it ever being over the counter, but I could see a model where a pharmacist can prescribe it or a medical professional. You won’t have to see, say, an infectious disease specialist where the wait may be weeks or months to get in.