The PrEP-Start under the magnifying glass: What does it involve? And how long does it take?
You have decided to use the PrEP to take? And would you like to start right now? Well, you can't just get PrEP at every corner. We asked prepsters, doctors, a checkpoint and a pharmacist what exactly is involved in starting PrEP and, above all, how long it can take from deciding to take PrEP to taking your first tablets. We also give you tips on what you need to think about before you can start PrEP.
A little patience is required when starting PrEP. We'll tell you what to look out for and how long it takes.
What do the PrEPsters say?
Volker
Volker comes from Berlin. He is 45 years old and has been taking PrEP since April this year. The decision has slowly matured for him. He heard about PrEP for the first time in the scene. "I then attended an information evening with the Berliner AIDS-Hilfe organisation and did some more research on my own," he says, describing his approach. He went to his GP in Berlin, who also looks after him otherwise. "I spoke to him again," he says. The detailed consultation encouraged Volker to start PrEP. He waited a week for the appointment. This was followed by the tests prescribed or recommended for PrEP: HIV, hepatitis B and sexually transmitted infections such as syphilis, chlamydia and gonorrhoea. After all the results were available a few days later, he received his first prescription for the blister PrEP and went to the pharmacy with it. After another two days, the time had come. Volker held his first blister with 28 PrEP tablets in his hands. "All in all, it took me 10 days before I was able to start PrEP"he summarises.
Marc
Marc is 47 years old and comes from Göttingen in Lower Saxony. The biggest difference to Volker, who can choose between several practices and pharmacies in Berlin, is that Marc does not have this choice in Göttingen. "A single doctor in Göttingen, who otherwise specialises in caring for patients with HIV, takes care of the PrEPsters in and around Göttingen," says Marc. Despite this somewhat difficult starting point, Marc only had to wait a week for his first appointment. And the time until the test results were available and he received his first prescription was also around 10 days for him. Marc doesn't have a pharmacy in Göttingen that can get him the blister PrEP. Marc therefore only has the option of choosing a more expensive product from another manufacturer. The advantage of this option is that the product is available immediately. All in all, it took Marc about two and a half weeks.
In order for a pharmacy to offer the blister PrEP, the pharmacy must participate in the blister pilot project. There are currently around 65 pharmacies in Germany that are also members of the German Association of HIV Competent Pharmacies. The pharmacy staff must also undergo additional training.
Marcel
Marcel had to make the greatest effort. He is 35 and comes from Karlsruhe in Baden- Württemberg. "There's not a doctor for miles around who looks after PrEPsters here," reports Marcel. He would have had to travel to either Stuttgart or Mannheim. Too much effort. Marcel finally approached his family doctor. "I literally spammed him with information," he describes his approach. "But my doctor responded really well and was willing to familiarise himself with a subject he wasn't used to." His doctor did some research and Marcel was back with him after 48 hours. Marcel has been able to take PrEP since this spring. And the family doctor also takes over the PrEP checks that are prescribed every three months. If you factor out the week it took Marcel to find a doctor, it also took two weeks from the first check-up to taking the first pill.
First stop: The doctors
Dr Kümmerle (Cologne)
"We also plan half an hour for an initial consultation."
Ebertplatz in the centre of Cologne. This is where Dr Tim Kümmerle She runs a joint practice with six colleagues. "A total of 150 patients who take PrEP come to us every quarter," says Kümmerle. Anyone who needs an appointment for an initial consultation waits between two and three weeks. "We also schedule half an hour for an initial consultation. And experience has shown that this is realistic." Kümmerle explains that the men who want to take PrEP are already quite well informed, but that one or two questions still come up during the consultation.
The consultation is followed by the usual tests for HIV and other sexually transmitted infections. Dr Kümmerle usually receives the results from his laboratory after three days. Only three times in the past two years has it not been possible to prescribe PrEP to a patient. "The first check revealed that two were already HIV-positive and a third had acute hepatitis," Kümmerle explains. The Cologne-based doctor sees his patients regularly, as the routine PrEP check is scheduled every three months. If everything is OK, the prescription is issued for the next three months.
"We also plan half an hour for an initial meeting. And experience has shown that this is realistic."
Dr Kümmerle (Cologne)
A waiting time of two to three weeks for an appointment for initial PrEP counselling is also possible in the practice of Dr Roger Vogelmann is the standard in Mannheim. There are two other practices in the city that offer PrEPster counselling. Dr Vogelmann shares his Cologne colleague's observations regarding the level of information and the need for advice among his patients.
Dr Vogelmann (Mannheim)
Dr Vogelmann cooperates with a checkpoint for PrEP.
The biggest difference to his colleagues in Cologne is that Dr Vogelmann cooperates with a checkpoint. "For capacity reasons and because it is more favourable for the PrEPster, we recommend that our patients have the prescribed checks there. We only determine the creatinine level, which provides information about the condition of the kidneys, here at the practice. The checkpoint cannot do this at the moment," he explained. This is so important because the active ingredients contained in PrEP can put too much strain on the kidneys in a few cases. So far, there have been no cases in his practice where he has been unable to prescribe PrEP.
Tip: On iwwit.de you will find two linked Lists of doctors in Germany who can advise you on PrEP and prescribe it.
In order for doctors to prescribe PrEP, they must have the official training materials on the PrEP active ingredient.
Second stop: The checkpoint
Max-Josef-Straße in Mannheim's Neckarstadt district is one of the most beautiful streets in Mannheim. Old stately houses and lots of trees. Here has KOSI.MA the competence centre for sexually transmitted infections in Mannheim. Every second Thursday and now every fourth Wednesday of the month, people can get tested for HIV and STIs here and receive comprehensive advice on all questions relating to safer sex and sexual health.
As with all counselling offered at the KOSI.MA checkpoint, PrEP counselling is anonymous.
"Since the beginning of the year, we have also been offering the PrEP check. We work with the PrEP check booklet developed by the Hamburg counselling centre Hein und Fiete. The blue booklet was reissued for our federal state in Baden-Württemberg in the working group for men who have sex with men (MSM) after consultation with Hamburg," reports Marc Fischer, head of the KOSI.MA checkpoint. As with all counselling offered here, PrEP counselling is anonymous. "We therefore work with the RKI code, a combination of numbers and letters of the first and last name," Marc explains the procedure. He and his team then forward the results from the laboratory directly to the treating doctors. This procedure has proven its worth.
Third station: The pharmacist
Ralf Busch is a pharmacist in Mannheim. In addition to a second pharmacy in the city, he is also authorised to dispense PrEP in blister packs. As described above, this is because he participates in the blister pack programme as a member of the DAHKA. A total of 60 PrEPsters come to him regularly. The vast majority of them buy the blister PrEP.
With the Blister-PrEP, the tablets are shrink-wrapped in small disposable bags (so-called blisters). At around 40 euros, the Blister-PrEP is cheaper than products from other manufacturers. However, unlike the blister PrEP, these are available immediately. If no weekends or public holidays delay the order, his customers have their Blister-PrEP within two days. He and his team do not usually have to spend a lot of time advising customers. "The guys are all well informed," says Busch, describing his impression. "If there are any questions, they usually relate to possible interactions with other medications that are also being taken."
The Blister-PrEP
PrEP: A final outlook
In autumn 2017, thanks to the commitment of a pharmacist in Cologne, PrEP was made relatively affordable and at the same time legally accessible to many people for the first time. One year on, many things are still not ideal. In some cities, the cheaper blister PrEP is still not available in pharmacies. Or there are no doctors who can provide it. The costs that everyone has to pay for a PrEP check at a doctor's appointment also vary: Depending on the practice, they can range from €30 to €75. And some people certainly wait longer than three weeks for an appointment for an initial PrEP consultation. But especially in larger cities, PrEPsters in Germany are quite well catered for.
Our tips to ensure that everything runs smoothly for YOU too:
- Remember, it takes an average of two to three weeks between the first call to the doctor to arrange a PrEP appointment and the day you receive your PrEP tablets.
- Find out which doctors can look after you and what costs are involved! Find out more at iwwit.de
- Of course, it is important that you have not been in a high-risk situation for 6 weeks before the HIV test at the doctor. Keyword "diagnostic window" from HIV tests.
All info about all checks before and during PrEP is also available at iwwit.de. - Once you've had your first appointment with the doctor, make an appointment for your next PrEP check as soon as you leave to avoid longer waiting times!
- Allow around two days for your tablets to be ordered - if you opt for the blister PrEP.
- Keep an eye on your supplies - get a repeat prescription in good time and take it to the pharmacy!
- Have fun having sex! 😉
Editor's note: The title of this article explicitly does not claim that the safer sex method PrEP offers 100 per cent protection against HIV. The same of course also applies to the other two safer sex methods, condoms and protection through therapy. This is why regular checks for HIV and other STIs are a must for everyone. More about the test on iwwit.de
