Starting the HIV PrEP Conversation in Primary Care and Pharmacy

"Starting the HIV PrEP Conversation in Primary Care and Pharmacy" takes up the question of how clinicians and pharmacists can start the PrEP conversation, and who should be having it.

Dr. Cocohoba notes that primary care physicians are often the first point of contact for HIV prevention. The conversation can hinge on a single question about sexual activity. Dr. Urbina explains that the data support a simple principle: the more clinicians ask about sexual health, the more open patients become and the more likely they are to start PrEP. He prefers to open with an open-ended prompt, asking whether there is anything about their sexual health the patient would like to discuss. Dr. Cocohoba describes this as a gentle invitation that carries far less pressure than detailed questions about partners and practices.

Turning the question around, Dr. Urbina asks how pharmacists approach PrEP. Dr. Cocohoba points to community pharmacists as prevention leaders who already deliver most vaccines in the United States. She describes practical cues for starting the conversation. These include a patient purchasing condoms or filling a prescription for a sexually transmitted infection or doxycycline postexposure prophylaxis. Dr. Urbina adds that pharmacies often exist in PrEP deserts where clinical infrastructure does not.

On the division of labor, Dr. Urbina argues PrEP should not be relegated to infectious disease specialists. Primary care, obstetrics and gynecology, and other disciplines can start oral PrEP once HIV-negative status is confirmed. They can then refer patients for long-acting options when needed. Dr. Cocohoba acknowledges the burden of keeping up with guidelines. She points to AIDS Education and Training Centers, national PrEP consultation lines, and experienced colleagues willing to mentor. Dr. Urbina notes that consultation makes sense for comorbidities or hepatitis B coinfection. Both agree clinicians must overcome their own discomfort and ask every patient. Those who never hear the question may never realize PrEP applies to them.

Our next episode, "HIV Testing Before and During PrEP: Getting It Right," turns to the baseline and follow-up HIV testing that keeps PrEP safe, from rapid point-of-care assays to viral load testing.