Over the past few years, a long-used HIV treatment, Truvada, has found new life as a tool for HIV prevention. Studies show that taking the once-a-day pill on a regular basis significantly reduces the risk of contracting HIV—to the point that there are only a couple of known cases where the drug, when taken properly, has failed. Since this revolutionary discovery, the drug has been widely-discussed, and some cities’ health services have even made the drug free for all citizens.

In Nashville, however, there was a long period when it was nearly impossible to find a provider willing to prescribe PrEP. That has begun to change in the last year thanks to the work of Nashville CARES in providing PrEP navigation services—guiding clients through the sometimes-confusing process.

“Originally, we received a grant through Gilead for PrEP navigation services and it started about March or April of 2016,” explained Jeff Tordiff, one of CARES’ PrEP navigators. “Starting in January we received an additional grant through the Tennessee Department of Health to increase our navigation services...”

Currently, CARES’ five PrEP navigators are Tordiff, as well as Zachary Papillion, Ronellis Tunstill, Sherman Megibben, and Jamie Regan. They are working to demystify the process and make sure that all interested parties have access to the information and, whenever possible, the medication they need.

PrEP’s success has made programs like these across the country a priority, but PrEP has limits. “When we talk to individuals about PrEP, we talk about it as part of their tool belt for prevention: for most people PrEP along with a condom is going to be your best barrier… If a condom breaks, you have PrEP as the backup.” In addition to the rare failure of the drug, Truvada alone doesn’t prevent STIs like gonorrhea, chlamydia, or syphilis, nor does it prevent pregnancy for female clients.

While PrEP is currently recommended for individuals who are having sex with multiple partners, who don’t consistently use condoms, intravenous drug users, or people with a positive partner, Tordiff said, “but our approach is that if you think PrEP is right for you, we are going to walk you through the process. We’re going to help you meet with a healthcare provider to decide for yourself—we aren’t going to make the decision whether we think they’re a good candidate for PrEP or not.”

“Once we have an interested party,” Tordiff said, explaining the process, “we’re going to meet with them one-on-one so we can discuss more in-depth not only what the PrEP process looks like but also about the medication and the importance of taking the pills at the same time everyday... We will also discuss their insurance information and figure out—whether or not they have insurance—what they need to do from there.”

Many resources are available, even for those without health insurance. “We have a good working connection with the Cayce Clinic as part of Neighborhood Health, where we have a nurse practitioner Kim Rivers who is really familiar with PrEP,” Tordiff explained, “so we can serve a lot of our people without insurance through her, because the visits are going to be on a sliding fee scale, we know the cost of the labs are going to be $25 and that will be billed later, so we can have them prepared for that.”

“For individuals with insurance it takes a little longer,” he added, “because we have to work with the specifics of their plan: what part, if any, of the medication does their insurance cover, and how can we get them in contact with a provider willing to provide the prescription who is also going to be a good fit. Then we have to work out what we need to do on the back end to make sure they can afford the medication.”

Once the process is in motion, things move quickly: if a client goes through the Cayce Clinic, they can generally have their prescription within a week or so of visiting Rivers. For those who qualify financially, PrEP navigators will also assist with applying to the Gilead Advancing Access program for copay assistance once the prescription is written.

Not everyone will be able to take the drug. Health barriers, such as impaired kidney function or having hepatitis, can mean Truvada is not a good fit. And financially, there are gaps in assistance, as when someone has insurance with a deductible or out-of-pocket that’s too high, even after the copay assistance, or when someone makes too much to qualify for Advancing Access.

Nevertheless, CARES will utilize all available resources to help clients get access to healthcare, and their services are still expanding. “As part of the grant the CDC gave Nashville CARES, Street Works, and Neighborhood Health, we are creating My House,” Tordiff explained, “which is a gay and bisexual men’s health clinic and wellness center.” In addition to HIV and full panel testing, Rivers will be in residence a few days a week to offer PrEP services, as well as basic health services, including common ailments.

For more information about PREP navigation, contact jtordiff@nashvillecares.org or visit the organizations website at nashvillecares.org.