On the first visit, the patient is given two injections, and two pill versions of the same drug to take in the clinic. Then, the patient is given two of the same pills to take home to take on the second day.

It is very important for patients to take the second-day pills, because doing so will ensure peak plasma concentration that same day. That means patients will have achieved optimal protection against HIV in as quickly as two days, which is impressive. If the patient fails to take the pills, that protection can be delayed by as much as 10 days.

After that, the patient only needs to come in every six months for injections, with a flexibility window of two weeks before and after the date.

The most common side effects occurred at the injection site. There were the usual pain, swelling, and itchiness reactions, and most were mild to moderate. However, there is an injection site reaction that occurred in a large proportion of patients—roughly 65 percent—which was described as the formation of a “nodule.”

To understand these nodules, we have to go into how this drug works. Yeztugo is injected into the subcutaneous layer, under the skin but above the muscle. A deposit of the drug sits there and dissipates over time. For many patients, the nodules might not be visible, although if you touch the site, you might feel a slight lump there.

For some patients, the nodules might be slightly visible and appear raised. Thus, patients are offered a choice on injection sites, and Yeztugo can be given in the abdomen area or the thigh. It is important to educate patients on what to expect.

And for some, the nodules never develop at all. It does not mean, however, that the drug is not working. It varies by patient.

One of the biggest challenges of daily oral PrEP is adherence. People are forgetful. When enough daily doses are missed, the protection wanes. Having an option every six months ensures there are no gaps.

The fact that you have to go into clinic for this option—while a hassle—is actually helpful for fighting stigma. Some people don’t like having these medications visible in their cabinets, or having to interact with pharmacists about them.

Lastly—this is less talked about—is the potential to bring more accessible HIV prevention into vulnerable communities and populations. It is harder to bring pills to a community and ask them to take them every day, and refill them every month, compared to giving injections just twice a year. Also, Yeztugo is approved for adolescents, which makes this accessible to younger people as well.

It starts with a conversation with your care provider. There are many different PrEP options out there, and if it is determined a patient would like to go with Yeztugo, an HIV test is done to ensure the patient is negative before starting the regimen.

And then, at subsequent visits, all the label for Yeztugo requires is to document that the patient is HIV negative. Gilead Sciences has not set any sort of protocol for maintenance testing.

However, just because this option is taken twice a year doesn’t mean that the patient should only go for screening that number of times. If a person is very sexually active, it’s a good idea to go for screening not just for HIV, but also other sexually transmitted infections, every three months.

The news media has reported that Yeztugo has a list price of roughly $28,000 per year, or about $14,000 per shot. That is a large price tag to swallow, but with commercial insurance, out-of-pocket costs are likely to be lower. Depending on an individual’s insurance, that copay might still be too high, though.

With Yeztugo’s approval being recent, insurance companies are waiting for guidance from state and federal regulatory bodies, including Medicaid. The New York State Department of Health’s AIDS Institute has already given an interim recommendation to clinicians for Yeztugo as a “preferred PrEP regimen,” as long the individual doesn’t mind injections every six months. I’m hopeful that insurance will soon cover Yeztugo on their list of covered drugs.