As a young woman, Daphne Chen would leave many interactions with healthcare providers about her sexual health that made her feel judged. Throughout her twenties, Chen found non-judgmental support from friends, and wanted to bring a no-nonsense sexual health approach to more people. So, in 2020, Chen and longtime friend Stephanie Estey founded telehealth company TBD Health, focused on offering sex-positive healthcare via at-home STD tests.
Since launch, the pair have built out TBD’s offerings to include a clinic in Las Vegas and at-home STD testing and emergency contraception, as well as sexual health telemedicine consultations in certain states. Earlier this year, TBD raised $4.4 million in seed funding it used to brings its at-home services to 50 states. Now the company is expanding its scope. On June 27, TBD launched a new kit to offer HIV pre-exposure prophylaxis through an at-home HIV test and telehealth visit.
“PrEP had always been top of mind for us,” Chen said. “It’s not widely known about. Meanwhile the patients we talk to who are in need of PrEP have a tough time accessing it because they don’t have a provider in their area who can help them stay on top of the three-month testing that’s required.”
Though there have been big strides in HIV treatments, to the point that well-managed HIV is both undetectable and untransmittable, roughly 13% of the 1.2 million people in the U.S. with it don’t know they have it—which means they could be transmitting HIV unintentionally. For people who might be exposed to HIV, PrEP reduces the chance of transmission. Yet, the CDC estimates less than a quarter of people who would benefit from PrEP are taking it. Furthermore, there are disparities between the groups that most need PrEP and those who are taking it. For example, women account for 19% of new HIV diagnoses but only 7.4% of people using PrEP.
“Men who have sex with men tend to be the focus of conversations around PrEP,” says Dr. David Wohl, a professor of medicine at UNC Chapel Hill. “As a result many of the groups who can also benefit from PrEP have never heard of it.
Even among those who are prescribed PrEP, adherence rates are abysmal—one study showed over the course of the study 52% of participants stopped usingPrEP (meaning they went 120 days without a refill) at least once. And though PrEP is covered under almost all health insurance plans, staying on a regimen requires visiting the doctor’s office every three months for repeat HIV tests. This can be difficult for people who live far away from clinics, and visits can add up, even if a patient’s prescription is covered under insurance or a manufacturer’s discount.
“There are lots of hidden costs even if PrEP is free,” Wohl says. “Blood testing and clinic visits are not typically free and drug companies aren’t allowed to pay for them.”
