Different models exist for the type of follow-up visits. For the models used below, some clinics use a hybrid model, such as clinic visits alternating with virtual visits, with an option to allow the person receiving HIV PrEP to drop in for laboratory and self-testing at their convenience. For persons receiving oral HIV PrEP with tenofovir DF-emtricitabine (TDF-FTC) or tenofovir alafenamide-emtricitabine (TAF-FTC), there may be options for virtual visits and off-site (or home) laboratory testing. Since persons receiving long-acting injectable cabotegravir (CAB-LA) are seen in the clinic every 2 months for cabotegravir injections, there is no real need or benefit for routine virtual visits or non-clinic-based laboratory testing.
- In-Clinic Visit / In-Clinic Laboratory Testing: With this model, the blood draw and sexually transmitted infection (STI) testing are ideally done on the same day as the clinic visit. The STI testing samples for chlamydia and gonorrhea can be obtained through either self-collected swabs or clinician-collected swabs.
- Virtual Visit (Telemedicine) / In-Clinic Laboratory Testing: With this model, the blood draw and STI testing are ideally done in the clinic several days prior to (or after) the 3-month follow-up virtual visit, or alternately, are ordered at the time of the virtual visit, with the goal for completion as soon as possible after the visit. The STI testing samples for chlamydia and gonorrhea can be obtained through either self-collected swabs or clinician-collected swabs.
- Virtual Visit (Telemedicine) / Off-Site or Mail-In Laboratory Testing: With this model, the individual has a virtual visit, and shortly before or after the virtual visit, the individual visits an off-site laboratory testing facility (that may be at a more convenient location than the clinic) or they obtain self-collected blood samples and STI samples at home. Samples collected at home are then mailed to an appropriate laboratory. The model that utilizes home testing is the least common of the three models, since mail-in, home self-testing has not become widely available, especially with testing that requires obtaining blood samples.
Telehealth Resources
Prime Health, in partnership with Washington University in St. Louis, has developed an outstanding, comprehensive suite of resources for health care providers who are interested in integrating telehealth services into HIV PrEP programs. These TelePrEP Hub resources include
- Practical information on designing a TelePrEP program,
- TelePrEP Readiness Assessment (a guide for program managers to assist in implementing TelePrEP),
- TelePrEP Billing and Compliance,
- TelePrEP Regulations and Policies, TelePrEP Client Navigation and Education, Electronic Device and Technology Assistance for TelePrEP Clients,
- TelePrEP Mental Health and Support Services,
- TelePrEP Counseling,
- HIV Prevention Support Tools and PrEP Messaging, and
- TelePrEP and Lab Testing, and TelePrEP and Pharmacies.