Toward Greater Pre-exposure Prophylaxis Equity: Increasing Provision and Uptake for Black and Hispanic/Latino Individuals in the U.S.

Abstract

Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition and is a critical tool in the Ending the HIV Epidemic in the U.S. initiative. However, major racial and ethnic disparities across the pre-exposure prophylaxis continuum, secondary to structural inequities and systemic racism, threaten progress. Many barriers, operating at the individual, network, healthcare, and structural levels, impede PrEP access and uptake within Black and Hispanic/Latino communities. This review provides an overview of those barriers and the innovative and collaborative solutions that health departments, healthcare organizations, and community partners have implemented to increase PrEP provision and uptake among disproportionately affected communities. Promising strategies at the individual and network levels focus on increasing patient support throughout the PrEP continuum, positioning and training community members to expand knowledge of and interest in PrEP, and leveraging mobile technologies to support PrEP uptake. Healthcare-level solutions include expanding the venues and types of healthcare professionals that can provide PrEP, and structural-and policylevel options focus on financial assistance programs and health insurance expansion. Key research gaps include demonstrating that pilot studies and interventions remain effective at scale and across varied contexts. Although the last 2 decades have provided effective tools to end the HIV epidemic, realizing this vision for the U.S. will require addressing persistent and pervasive HIV-related disparities in Black and Hispanic/Latino communities. Federal, state, and local partners should expand efforts to address longstanding health and structural inequities and partner with disproportionately affected communities to rapidly expand PrEP scale-up.

HIV Linkage to Care and Pre-Exposure Prophylaxis Among Persons in Non–Health Care Sites Who Are Tested for HIV for the First Time, United States, 2019

“…to deliver services that address health disparities and inequities. 31 Our findings support efforts in non-health care sites to increase HIV testing, PrEP awareness, and prompt referrals to PrEP and HIV treatment services for persons who have never previously tested. Non-health care sites working with health departments should consider enhancing outreach efforts to increase HIV testing and PrEP education, particularly for young persons who have never tested, offering PrEP and HIV treatment services or engaging providers who do, and obtaining capacity-building assistance to support persons most in need of services.…”

Changes in Substance Use and Sexual Behaviors After a Sexually Transmitted Infection Diagnosis Among a Cohort of Men Who Have Sex With Men in Los Angeles, CA

“…26 Consideration of racial/ethnic disparities in uptake of PrEP represents an important challenge in addressing the HIV epidemic among MSM, as this population experiences additional individual, network, and structural-level barriers to PrEP use. 27 Effective evidence-based approaches to engage minority MSM are needed to address this gap in coverage. Peer-based intervention approaches, such as peer navigation, which bridges the gap between patient and provider by providing peer support in navigating HIV services, are a promising approach to improving HIV service uptake among key populations.…”

Knowledge and Attitude About Pre-exposure Prophylaxis Among Primary Care Clinicians at a Federally Qualified Health Center in Central Texas: A Cross-sectional Study

“…The FQHC system in the present study implemented a PrEP referral program, yet the PCPs were still concerned about increasing their workload. To reduce the burden of PrEP follow-up visits on PCPs, flexible practice models should be explored, with nurse and/or pharmacist visits for monitoring laboratory studies and follow-up and telemedicine visits with laboratory-only appointments for PrEP follow-up (Bonacci et al, 2021). PrEP programs incorporating pharmacists as counselors and providers have demonstrated success and can be used for both initiation and follow-up with PrEP patients, which could alleviate the workload concern.…”