One-Stop PrEP: On-Site Pharmacy Boosts Client Uptake

One of GMHC’s top goals was to make it easier for clients to take care of their sexual health, Tingwane said. Notably, the pharmacy, which opened in October 2022, offers convenient access to PrEP (pre-exposure prophylaxis) for HIV prevention. 

GMHC partnered with Q Care Plus to provide telePrEP services for clients in May 2022. TelePrEP services proved successful in increasing clients’ PrEP uptake, so the agency opened an on-site pharmacy with Q Care’s sibling company, Avita Pharmacy. 

“Having the pharmacy on site, with Q Care Plus as the healthcare provider for prescriptions, has exponentially increased the number of our clients on PrEP,” Tingwane said. In response to client requests, GMHC also started offering Doxy-PEP (doxycycline) as a post-exposure medication for STI prevention last November. 

PrEP is a critical tool for reducing HIV transmission, because the medication is 99% effective in preventing HIV when taken as prescribed. However, it requires a medical prescription and regular HIV and STI testing every three months for refills. 

Before the onsite Avita Pharmacy, GMHC’s Testing Center had referred many HIV testing clients to its network of medical providers across New York City for PrEP prescriptions. But there was a roughly 50% attrition rate for referrals, Tingwane said. Clients often didn’t make an appointment with the clinician or missed appointments, discouraged by long wait times, difficulty navigating insurance requirements, and prohibitive out-of-pocket costs. 

“Clients can come into our office to get testing, receive counseling, and then have a telehealth visit with a Q Care Plus provider for a PrEP prescription and get it filled onsite at the Avita Pharmacy,” Tingwane said. Clients can also obtain PrEP remotely. The Testing Center provides an HIV self-test kit, follow-up counseling and then links the client to a Q-Care Plus provider for a prescription that can be filled online with Avita. 

TelePrEP appointments with Q Care Plus clinicians now make up over 80% of the Testing Center’s total referrals to medical providers. The rest are still to in-person providers. “When there are a lot of handovers, you lose people,” Tingwane said. “If we can assist them in one sitting, where they come to the Testing Center and leave with a prescription, that produces much better outcomes.” 

“Having the pharmacy at GMHC offers convenience, comfort, and safety as well,” he added. Q Care Plus and Avita are both staffed by culturally competent providers to supply LGBTQ+ clients with stigma-free health care. That allows clients to fill their prescriptions in a welcoming, secure space, instead of using a pharmacy in their neighborhood. 

Doxy-PEP and STI Prevention 

GMHC started offering Doxy-PEP through the on-site pharmacy last November. That was just a month after the U.S. Centers for Disease Control (CDC) released its first-ever recommendations on using the antibiotic as an STI prevention tool for men who have sex with men (MSM) and transgender women. Both are disproportionately affected by the national increase in syphilis, gonorrhea, and chlamydia infections. 

Doxy-PEP works like a “morning-after” pill for these three STIs, reducing the risk of infection by about two-thirds when taken within 24 to 72 hours of potential exposure. “It’s an added benefit for clients on PrEP,” Armstrong said, noting that they may be having condomless sex. 

Testing Center counselors can connect clients taking PrEP with a Q Care Plus clinician for a Doxy-PEP prescription to fill at the pharmacy. That way they can have the medication on hand in case of STI exposure. “Our philosophy is harm prevention,” Tingwane said. “We don’t judge.” 

For PrEP and Doxy-PEP services, the Avita Pharmacy at GMHC is enrolled in the federal 340B program for health centers that serve low-income and uninsured people. That allows the pharmacy to purchase prescription drugs at significantly reduced prices and pass on the savings to the agency to bolster its services for clients. 

Doxy-PEP is relatively inexpensive, but PrEP often isn’t. “All GMHC clients who are HIV–negative are eligible for free PrEP services,” Tingwane emphasized. 

GMHC covers the cost of HIV/STI testing and lab work, and clinician fees. The cost of the medications themself is covered by insurance. The Testing Center can connect uninsured clients with GMHC’s insurance navigation team to help them obtain health insurance through an Affordable Care Act plan, Medicare, or Medicaid.