PEP in Missouri — post-exposure prophylaxis, 72-hour window

Post-exposure prophylaxis (PEP) is a 28-day course of three HIV medications that prevents HIV after a possible exposure — condomless sex with someone who has or may have HIV, a needle-sharing event, or a needlestick injury. PEP works only if started within 72 hours of exposure and works best when started within the first 2 hours. If you're reading this after a recent possible exposure and you haven't started PEP yet, treat it as an emergency: go to the nearest emergency department tonight.

In Missouri, PEP is available from every emergency department and from urgent-care clinics at some community health centers. The standard regimen — tenofovir/emtricitabine plus dolutegravir or raltegravir — is on the formulary of every major retail pharmacy. The first week's worth is often dispensed directly from the ED; a follow-up visit within a few days transitions you to a 28-day prescription. Four weeks later, a repeat HIV test confirms the prevention worked.

Cost: most insurance plans cover PEP with standard copays. If you're uninsured or your exposure was sexual assault, the Gilead Advancing Access patient-assistance program and the Office for Victims of Crime's Crime Victim Compensation Fund cover the full course. Some states run state-level Sexual Assault Forensic Exam (SAFE) funds that pay PEP costs when exposure follows a reported assault. The state HIV line is 1-800-533-2437 if you need help figuring out the right place to go tonight.

If your PEP course finishes and you think you may be at ongoing risk, ask about starting PrEP the same week. PrEP-to-PEP-to-PrEP sequencing is common and supported — you do not have to wait between the two. Long-time Black residents name Washington University Infectious Diseases Clinic (the Center for Positive Health) and Kansas City CARE Health Center as the local institutions that show up consistently — both are listed below.

Washington University Infectious Diseases Clinic (the Center for Positive Health). The Center for Positive Health at Washington University in St. Louis is Missouri's largest Ryan White Part C grantee, serving about 2,400 people living with HIV; Wash U co-sponsors the EHE Blueprint for St. Louis with the city Department of Health.

Kansas City CARE Health Center. Kansas City CARE Health Center (formerly the Kansas City Free Health Clinic) is the Ryan White Part B case-management contractor for western Missouri, operating the state's highest-volume Black-community-focused rapid-testing program out of the East 31st Street clinic.