Preexposure Prophylaxis of HIV Infection: the Role of Clinical Practices in Ending the HIV Epidemic

Zablotska, Iryna; O’Connor, Catherine

doi:10.1007/s11904-017-0367-7

Cited by 25 publications

(23 citation statements)

References 76 publications

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“…24,77 And reviews of implementation efforts demonstrate that PrEP rollout is successful when government provides financial support and is impeded when such support is lacking. 78 Recommendations for systems-level intervention strategies include expanded funding for medication costs generally, 5 and specifically lowering the price of PrEP medication itself. 4 Current implementation efforts include supporting patients in navigating PrEP payment options, 79 which includes state-run programs that cover PrEP-related medical out-of-pocket costs in conjunction with the manufacturer's copayment assistance program for medications; one state (Washington) actually pays for the medications directly.…”

Section: Current Guidelines For Prep Prescription and Follow-up May Bmentioning

confidence: 99%

Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men

Golub

Myers

2019

AIDS Patient Care and STDs

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Data indicate that diffusion of pre-exposure prophylaxis (PrEP) programs for HIV prevention is increasing in the United States; however, persistent disparities in PrEP access remain. Earlier waves of PrEP implementation focused on development (2012)(2013)(2014)(2015) and diffusion (2016)(2017)(2018). To reduce disparities, the next wave of PrEP implementation should focus on integration; that is, the assimilation of PrEP service as an integral part of HIV prevention, sexual health, and primary care. This review analyzes PrEP implementation literature in the context of three ''next-wave'' challenges: increasing patient demand, enhancing provider investment and competency, and improving health systems capacity. Our review revealed five activities we consider critical to successful next-wave PrEP implementation efforts: (1) redefining PrEP eligibility assessment, (2) de-emphasizing risk perception as a strategy to increase demand, (3) rejecting risk compensation arguments, (4) altering guidelines to make PrEP follow-up less onerous, and (5) focusing directly on strategies to reduce the cost of PrEP medication. This article ends with a case study of a research-practice partnership designed to instantiate new approaches to integrative implementation efforts.

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Section: Current Guidelines For Prep Prescription and Follow-up May Bmentioning

confidence: 99%

Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men

Golub

Myers

2019

AIDS Patient Care and STDs

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“…Fixed-dose combination tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) for pre-exposure prophylaxis (PrEP) has been found to be highly efficacious in HIV prevention, reducing the risk of HIV acquisition by 86% [1, 2]. Many countries have since approved TDF/FTC for this indication [3], including Australia in May 2016.…”

Section: Introductionmentioning

confidence: 99%

Renal function and risk factors for renal disease for patients receiving HIV pre-exposure prophylaxis at an inner metropolitan health service

et al. 2019

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BackgroundPre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) significantly reduces the risk of HIV acquisition. TDF is a known nephrotoxin however, renal dysfunction from TDF is mostly reversible following discontinuation.AimsTo describe the renal function, risk factors for renal disease and associated clinical testing practices in a cohort of PrEP patients.MethodsA retrospective review was conducted of all PrEP patients commenced on TDF/FTC at an inner metropolitan sexual health clinic in Sydney, Australia between April 2016 and July 2017, with follow-up data obtained at 3-monthly intervals until 18 months.Results525 patients met inclusion criteria. Patients were almost exclusively male and median age was 34 years (IQR: 28 to 42). At baseline, 1.5% had an estimated glomerular filtration rate (eGFR) <70 mL/min/1.73m2. A small significant drop in eGFR of -2.5 mL/min/1.73m2 (p<0.05) occurred between PrEP commencement and the first follow-up period, followed by a progressive decline in eGFR of -0.38 mL/min/1.73m2 per month (95%CI: -0.57 to -0.20; p<0.001). Renal impairment (eGFR <70 mL/min/1.73m2) occurred in 6.5% of patients and persisted across consecutive follow-up periods in five (1.0%) patients. Patients aged ≥40 years had a greater risk of renal impairment than younger patients (HR 3.9, 95%CI: 1.8 to 8.4; p<0.001), despite similar rates of eGFR decline (p = 0.19). PrEP was discontinued in two patients (0.4%) due to renal function concerns.ConclusionPrEP use led to an initial drop in eGFR and a more gradual progressive decline subsequently, but significant renal impairment remained uncommon up to 18 months of follow-up.

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“…Since FDA approval, overall PrEP awareness has grown with four recent surveys of clinicians demonstrating awareness between 64%-93% (10)(11)(12)(13). In addition, clinician willingness to prescribe PrEP has increased, particularly among infectious disease specialists and HIV care providers relative to primary care providers (14)(15)(16)(17)(18)(19). However, a key concern is that the growth in awareness has not corresponded with an increase in the number of providers who prescribe the medication.…”

Section: Introductionmentioning

confidence: 99%

HIV Pre-Exposure Prophylaxis (PrEP) Knowledge, Familiarity, and Attitudes among Healthcare Professional Students

Przybyla¹,

Fillo²,

Kamper‐DeMarco³

et al. 2019

Preprint

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Background The federal government’s plan to End the HIV Epidemic by 2030 includes a primary goal to reduce new HIV infections by 90 percent. One key contributor to this plan is pre-exposure prophylaxis (PrEP), a medication taken by HIV-uninfected individuals to prevent infection. While knowledge and acceptance of PrEP among clinicians is growing, few studies have assessed knowledge and awareness among future healthcare professionals in academic training programs. Given the limited research on PrEP among healthcare professional students, a better understanding of knowledge and familiarity with PrEP prescription may inform the development of educational interventions targeting this population in an effort to increase implementation. The present study aimed to assess and compare healthcare trainees’ PrEP awareness, knowledge, and familiarity with prescription guidelines with a broad goal to better understand and prevent gaps in academic training regarding PrEP. Methods A cross-sectional web-based survey of medical, nurse practitioner, and pharmacy students enrolled at two universities was conducted between October 2017-January 2018. The study assessed participants’ awareness, knowledge, and familiarity with PrEP prescribing guidelines and willingness to prescribe PrEP and refer to another healthcare provider. Results The survey was completed by 744 participants (overall response rate = 36.2%). There were significant differences among student groups in all domains. Pharmacy students had the greatest PrEP knowledge, awareness, and familiarity with prescribing guidelines. However, medical students reported the greatest comfort with performing PrEP-related clinical activities and willingness to refer a candidate to another provider. Greater familiarity with PrEP prescription guidelines was associated with willingness to prescribe the medication. Conclusions Healthcare professional students’ responses enhance our understanding of the relevant experiences and perspectives of future healthcare providers that influence their knowledge towards the promotion of PrEP through prescription and referral intentions. The gaps in students’ knowledge offer opportunities for the development of educational strategies to support HIV prevention among future healthcare professionals.

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Preexposure Prophylaxis of HIV Infection: the Role of Clinical Practices in Ending the HIV Epidemic

Cited by 25 publications

References 76 publications

Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men

Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men

Renal function and risk factors for renal disease for patients receiving HIV pre-exposure prophylaxis at an inner metropolitan health service

HIV Pre-Exposure Prophylaxis (PrEP) Knowledge, Familiarity, and Attitudes among Healthcare Professional Students

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