HIV Preexposure Prophylaxis—The Role of Primary Care Clinicians in Ending the HIV Epidemic

Khalili, Joshua; Landovitz, Raphael J.

doi:10.1001/jamainternmed.2019.5456

Cited by 15 publications

(14 citation statements)

References 23 publications

(27 reference statements)

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“…In summary, successful integration of PrEP into HIV screening and prevention services has the potential to reduce HIV incidence in the USA, and help achieve the US government's goal of ending the HIV epidemic in the USA by 2030 [147,148]. However, optimal impact of PrEP as a preventive intervention is yet to be realized.…”

Section: Discussionmentioning

confidence: 99%

“…Efforts of the US Department of Health and Human Services' ''Ready, Set, PrEP'' program may help to address the unmet need in this population through provision of PrEP medication at no cost to qualifying recipients. This initiative is a component of the US government's wider plan to ''End the Epidemic,'' which aims to reduce new HIV infections in the USA by 75% in 5 years and by 90% by 2030 [147,148].…”

Section: Potential Solutions To Barriersmentioning

confidence: 99%

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Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

2020

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Antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV transmission was first approved by the US Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest where PrEP has been deployed, the uptake of PrEP is lagging, particularly among populations with disproportionate HIV burden. This narrative review seeks to identify individual and systemic barriers to PrEP usage in the USA. A comprehensive search of recent literature uncovered a complex array of structural, social, clinical, and behavioral barriers, including knowledge/awareness of PrEP, perception of HIV risk, stigma from healthcare providers or family/partners/friends, distrust of healthcare providers/systems, access to PrEP, costs of PrEP, and concerns around PrEP side effects/medication interactions. Importantly, these barriers may have different effects on specific populations at risk. The full potential of PrEP for HIV prevention will not be realized until these issues are addressed. Strategies to achieve this goal should include educational interventions, innovative approaches to delivery of HIV care, financial support, and destigmatization of PrEP and PrEP users. Until then, PrEP uptake will continue to be suboptimal, particularly among those who need it most.

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Section: Discussionmentioning

confidence: 99%

Section: Potential Solutions To Barriersmentioning

confidence: 99%

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

2020

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“…24 Disseminating PrEP as a major method of HIV prevention remains limited in the United States, but recent calls by the federal government and physicians for the end of HIV have renewed focus on PrEP, including plans to expand access within primary care and community clinics. 25,26 Although primary care clinics may appear to be the most logical locations for dissemination, HIV clinics provide insight into methods of incorporating PrEP successfully into a multidisciplinary clinic model using a targeted approach that addresses common barriers with clear protocols. The HIV clinic model also demonstrates that funding that supports multidisciplinary teams and addresses gaps in financial support, beyond cost of medication, will help expand PrEP access and combat systemic, provider, and patient-related barriers to PrEP uptake.…”

Section: Unlocking Prep Delivery 255mentioning

confidence: 99%

Unlocking HIV Pre-Exposure Prophylaxis Delivery: Examining the Role of HIV Providers in Pre-Exposure Prophylaxis Care

Kenison

Badenhop

Safo

2020

AIDS Patient Care and STDs

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Despite being a promising prevention strategy for populations at risk for HIV acquisition, there has not been rapid uptake of HIV antiretroviral pre-exposure prophylaxis (PrEP). Yet, HIV clinics within the Mount Sinai Health System in New York City have successfully incorporated PrEP. HIV care providers (n = 18), who practice in these clinics and were early PrEP adopters, participated in a survey and semistructured interview. Qualitative thematic analysis revealed that barriers and facilitators to PrEP uptake were identified on multiple levels from broader systemic to provider-and-patient-level concerns. The following themes were identified: (1) to reach a greater proportion of patients at risk for HIV and address racial/ethnic and gender disparities, PrEP should be available in a variety of settings and provided by different types of providers within proximity to affected populations; (2) financial support is needed beyond addressing medication cost; and (3) multidisciplinary teams and populationspecific clinic protocols can assist providers in conducting high-quality visits and addressing these barriers to PrEP.

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“…More than a million individuals in the US are living with HIV [1]. In recent years, pre-exposure prophylaxis (PrEP) medication for individuals who are HIV negative but at risk of acquiring HIV has become an important method of HIV prevention and a key part of the overall plan for ending the HIV epidemic in the US [2][3][4]. PrEP has been shown to be highly effective in preventing HIV in both clinical trials and real-world studies, with the estimated effectiveness dependent on adherence [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Patient-Focused Selection of PrEP Medication for Individuals at Risk of HIV: A Narrative Review

Fields

Tung

2021

Infect Dis Ther

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Pre-exposure prophylaxis (PrEP) medication is a key component of the HIV prevention strategy in the US, which has been demonstrated to be highly effective in preventing HIV acquisition among individuals at risk. Two PrEP medications are currently approved: emtricitabine/ tenofovir disoproxil fumarate (Truvada Ò ; F/TDF) was approved by the US Food and Drug Administration in 2012, followed by emtricitabine/tenofovir alafenamide (Descovy Ò ; F/TAF) in 2019. An ongoing randomized, double-blind, Phase 3 study (DISCOVER) demonstrated that F/TAF had non-inferior efficacy to F/TDF. While both medications have been found to be efficacious and well tolerated, several studies have identified that important differences exist with regards to pharmacokinetics, bone and renal safety profiles, and other factors. In this narrative review, we conducted a comprehensive evaluation of the populations at risk of HIV who may also be affected by, or at risk of, bone or renal conditions. We reviewed the safety profiles of F/TDF and F/TAF to develop an evidence-based algorithm for selecting the appropriate PrEP medication, based on biological, behavioral, and health characteristics of an individual at risk of HIV, and considered how the choice of PrEP medication may or may not compound safety concerns for these individuals. We identified that the introduction of F/TAF provides a valuable alternative to F/TDF, allowing the personalization of PrEP. F/TAF may be the preferred medication for cisgender men and transgender women at risk of HIV infection who are predisposed to, or already have, bone or renal conditions. While the approval of F/TAF is the first step in personalization of PrEP, additional options are still warranted to help accommodate the wide spectrum of individuals at risk of HIV with different lifestyles, medical histories, preferences, and requirements.

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HIV Preexposure Prophylaxis—The Role of Primary Care Clinicians in Ending the HIV Epidemic

Cited by 15 publications

References 23 publications

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

Unlocking HIV Pre-Exposure Prophylaxis Delivery: Examining the Role of HIV Providers in Pre-Exposure Prophylaxis Care

Patient-Focused Selection of PrEP Medication for Individuals at Risk of HIV: A Narrative Review

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