HIV prevention goes virtual
UVic grad Mike Cousins started “Freddie” as a new way to provide HIV prevention services
Early in the COVID pandemic, UVic Computer Sciences grad Mike Cousins, BSc ’05, helped launch PurposeMed, an online platform connecting people living in remote, marginalized or underserved communities with health care services. Building on that model, Cousins and his team pivoted PurposeMed into Freddie (gofreddie.com). The virtual-care company focuses on HIV prevention by helping people access PrEP, a one-a-day pill that reduces the risk of acquiring HIV by 99 per cent. Since launching last July, Freddie has become one of, if not, the largest HIV prevention services in Canada. Cousins, Vice President Software Development, tells us what he learned about providing virtual health care during a pandemic, the future of telemedicine and why his company’s name was partially inspired by the mustachioed frontman of Queen.
Q: What does Freddie provide that is absent or lacking in health care?
MC: Over 50 per cent of new HIV infections are in the LGBTQ2S+ community, and HIV PrEP is hard to access.
Firstly, not all physicians are knowledgeable or able to prescribe HIV PrEP. For example, in Alberta, less than 2 per cent of physicians are licensed to prescribe it. It is a big challenge for patients to find expert, knowledgeable clinicians for PrEP.
Secondly, PrEP involves lab testing and multiple visits with clinicians. We’ve developed technology to streamline the whole process. With Freddie, a patient can access PrEP in a few days. It can take months in the traditional healthcare system.
Finally, PrEP is fully covered in some provinces. But in others, patients need to pay. Freddie has created financial assistance programs to lower the cost for patients who do need to pay. Ninety per cent of Freddie patients get PrEP for free.
At Freddie, we also have a team of care coordinators whose roles, among other things, include guiding patients through our program and assisting with confusion regarding insurance, pharmacy logistics, and other pain points.
Q: Why is the service called Freddie?
MC: It is loosely based on Freddie Mercury! We view him as a mold-breaking musician, and that is very much what Freddie is trying to achieve by de-stigmatizing conversations about sexual health.
Also, two of our co-founders have roots in Zanzibar, where Freddie Mercury was born!
Q: What inspired the pivot of PurposeMed to Freddie?
MC: Our mission and north star has always been to provide care to marginalized communities. As PurposeMed, we were trying to provide “walk-in” style telemedicine to rural and remote Canadians who tend to have lower access to family physicians and health care more broadly. But we came to realize that this need was being served by larger telemedicine companies that had existed for years.
However, we saw a gap in complex conditions. Conditions that require multiple visits with a physician, lab testing and continuity of care. That’s what led us to HIV prevention and Freddie.
Q: What do you have to take into consideration when a large percentage of your user base is new to telemedicine?
MC: It goes without saying, but designing a simple user experience is paramount. Things need to be simple for both patients and for clinicians. One surprising learning for us was how a majority of patients and physicians preferred phone consults to video. The reality is that using the phone is something we’re all used to, and there are often glitches with video. Initially we were trying to push everyone to video, but we’ve learned that phone consults work great too and are just as effective the majority of the time.
Q: Do you see telemedicine supplanting in-person patient-physician interaction as the preferred mode of certain types of health care?
MC: While there are some things that can only be done in person, we believe telemedicine will continue to grow quickly. The benefits for patients are obvious. As an example, when virtual visits were used In Ontario for outpatient follow-up stroke care, patients reported a total time savings of 80 minutes per visit and median out-of-pocket costs savings of $52.83. Clinicians also love the flexibility it provides.
We expect to see more services being offered virtually, both as start-ups such as Freddie combine people/processes/technology, and clinicians also seek to re-organize their work, for example by spending Monday to Wednesday in the office, and Thursday and Friday working from home.
Q: Freddie is currently focused on PrEP. Do you anticipate Freddie expanding its focus?
MC: Absolutely! The next area we plan to expand to is mental health. Mental health was an epidemic prior to COVID, but has become exacerbated by people being locked up in their homes. We’re looking at various ways to roll out free mental health services for Freddie patients. We’re also looking at ways to provide more sexual-health services to our patients, such as more convenient STI testing and treatment.
And finally, we’re looking at other complex conditions outside of HIV prevention where we think we can provide high quality care, virtually.
Q: What have been some of the challenges in launching Freddie?
MC: Inconsistency in coverage for health services can definitely be a challenge depending on the province we’re working in. Each province deals with PrEP differently. In Alberta and Saskatchewan, past legislators put systems in place that allow residents to access PrEP free of charge (out of pocket, the medication costs $250+ a month). Others, like Ontario or Quebec, may cover certain segments of the population, but leave others without coverage. Those individuals usually have to turn to private insurance or pay out of pocket. We have developed an in-house financial assistance program to help in these situations.
Ultimately, we have to conduct in-depth research of each province’s coverage options and resources before entering. We also have to ensure we are meeting all the regulatory requirements when it comes to lab testing, pharmacy partners, our telecommunication platform, methods of data collection, etc.
As the head of our software team, I’ve spent many nights ensuring our platform is up to par with the myriad of regulations we face!
Q: What has been the greatest reward?
MC: There are so many unique individuals at Freddie. It’s really a company like none other. Not only is it extremely enjoyable (even through remote work) but the people here are quite diverse and push me to think beyond the boundaries I may be used to.
Working at a start-up can also be risky. A big reward at Freddie has been the amount of successful projects I’ve been able to lead. Through our various provincial launches, as well as regularly building out our online portal or website, we are able to celebrate small victories and use those to motivate us during confusing and ambiguous moments.
Finally, I feel like I’m making a difference. My technical skills and experience could easily be put to use at some behemoth tech giant—but the tangible difference Freddie is making in Canadians’ lives is what makes this job unique. We are bridging a gap, trying to fix an issue that has been historically sidelined. Hearing from patients and community partners about how much easier we are making sexual health for the communities we serve is the most satisfying reward at the end of the day.
—Michael Kissinger, BEd ’94