Source: Bay Area Reporter

By Matthew S Bajko

February 9, 2017

 

The two urgent care centers in the Castro are now offering treatment to patients who believe they may have been exposed to HIV in order to prevent them from acquiring the virus.

Direct Urgent Care will also begin prescribing the HIV prevention pill known as PrEP to its patients as of March 1, while Dignity Health-GoHealth Urgent Care is discussing if it will follow suit, the Bay Area Reporter has learned.

As of last Wednesday, February 1, Direct Urgent Care began offering PEP, an HIV post-exposure prophylaxis treatment meant to be taken within 72 hours of possible exposure to the virus. The locally owned chain of urgent care centers operates out of a ground-floor retail space in the Linea building on upper Market Street.

Patients in need of PEP can make an appointment by phone or online to be seen that day.

Although the center will not officially start prescribing a month's worth of PrEP, the once-a-day pill that prevents HIV, to patients at its San Francisco location until next month, if someone needs PrEP immediately the center will work to accommodate them.

Both men and women can request either PEP or PrEP at Direct Urgent Care's center. The cost for the visit is $175, while the prescription price for the medicine varies based on a person's health insurance plan.

"If members of the community have this need, they now get to walk in to our center and we have a protocol to get you started," Dr. Caeser Djavaherian, a co-owner of the center, announced Thursday, February 2 during the monthly meeting of Castro Merchants, the neighborhood business association.

Because a person needs to first be tested to ensure they are HIV-negative prior to starting on PrEP, and some counseling about the medicine is involved, an in-person visit to the center is required. In an interview, Djavaherian told the B.A.R. that after the center helps get people started on PrEP it will refer them to other resources in the city for ongoing access to the medication.

Since Direct Urgent Care opened at 1998 Market Street in late July, it has fielded multiple requests from mostly male patients for both PEP and PrEP, said Djavaherian. 

Patients were also coming to Direct Urgent Care's center after being told by the nearby Dignity Health-GoHealth Urgent Care center, which opened in August a few blocks away at 2288 Market Street, that it was not providing such services. 

After the B.A.R. inquired with GoHealth if it planned to offer the HIV prevention medicines, Dr. Erick Miranda told the B.A.R. that as of Wednesday, February 8 all eight of its Bay Area centers, including the Castro location, would begin offering PEP to patients. 

"It is certainly something, for the health of the community, we definitely would offer," said Miranda, noting that its Castro center in particular had been fielding requests for both PEP and PrEP from men in the neighborhood.

Because PEP is an emergency HIV prevention tool, Miranda said it "definitely is within the realm or scope of our practice. We are very excited to offer it."

Since PrEP is taken on an ongoing basis, it falls into the category of primary care, noted Miranda, which GoHealth's urgent care centers are not meant to provide.

Nevertheless, due to the increasing popularity of urgent care centers as easier alternatives to seeing a primary care physician, as well as cheaper than going to an emergency room, Miranda said GoHealth is discussing if it makes sense for it to add PrEP to the services it offers.

"For patients who want to go on PrEP, which I highly endorse for patients at risk of HIV infection, it does require some primary care, such as ongoing testing," said Miranda. "As urgent care becomes more popular in the city, the lines between urgent care and primary care start to blur a little bit. It is an ongoing discussion amongst our group."

As for Direct Urgent Care, its Castro center had been directing its male patients looking for PEP or PrEP to seek the medications from Strut, the gay and bisexual men's health center on Castro Street operated by the San Francisco AIDS Foundation.

Because it is open at hours and on days that Strut is not, Direct Urgent Care decided it made sense for it to prescribe PEP and PrEP directly to its clientele. It also sees its doing so as a way to support the city's Getting to Zero initiative, which aims to reduce new HIV cases by 90 percent come 2020.

"Our clinicians and staff are committed to the prevention of new HIV infections in San Francisco and the entire Bay Area," stated Aurora Helm, a certified physician assistant and Direct Urgent Care's lead PEP/PrEP clinician. "By working closely with our community partners to expand access to care, plus provide a safe, convenient, and confidential place to receive PEP and PrEP, we are removing stigma or barriers patients typically face in accessing these services."

Strut officials did not respond to the B.A.R.'s request for comment by press time.

Alberto Lammers, director of communications at San Francisco's LGBT Community Center, which is a short walk from Direct Urgent Care, applauded the launch of the HIV prevention services at the center. The center often fields questions from people asking where they can access PEP and PrEP in the city, Lammers told the B.A.R.

"I think access to health care is very important to our community, especially to PEP and PrEP," said Lammers. "It is great to see them put this program into effect."

Direct Urgent Care is offering PEP at all four of its centers in the Bay Area. In addition to the San Francisco location, there are centers in Berkeley, Oakland, and Mountain View. While PrEP is only being offered at its San Francisco location for now, it plans to add PrEP at the other three sites later this year.

"The other centers will be learning from the San Francisco center's experience," said Djavaherian. 

For more information, visit http://www.directurgentcare.com.

Appointments for those seeking PEP at GoHealth can be made online or by phone for the same day. Patients can also walk into a center during its business hours and request to be seen.

Visits cost $250 at GoHealth for those without health insurance, while the price varies by plan for those who have coverage, as does the co-pay cost for the PEP prescription. Miranda said he was unsure how much the PEP prescription would cost those without health insurance.

For more information, visit /bayarea.