A new CDC report estimates that 25 percent of sexually active gay and bisexual adult men, nearly 20 percent of adults who inject drugs, and less than one percent of heterosexually active adults are at substantial risk for HIV infection and should be counseled about Preexposure prophylaxis (PrEP), a medicine taken daily that can be used to prevent getting HIV. However, the report also finds one in three primary care doctors and nurses have not heard about PrEP. Increasing awareness of PrEP and counseling for those at substantial risk for HIV infection is critical to realizing the full prevention potential of PrEP.
PrEP, the pill (brand name Truvada) which contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV, was approved for HIV prevention by the FDA in 2012. When taken daily, it can reduce the risk of sexually acquired HIV by more than 90 percent. Daily PrEP can also reduce the risk of HIV infection among people who inject drugs by more than 70 percent. When taken every day, PrEP is safe and highly effective in preventing HIV infection. PrEP is even more effective if it is combined with other ways to prevent new HIV infections like condom use, drug abuse treatment, and treatment for people living with HIV to reduce the chance of passing the virus to others.
“PrEP isn’t reaching many people who could benefit from it, and many providers remain unaware of its promise,” said the CDC Director Tom Frieden, M.D., M.P.H. “With about 40,000 HIV infections newly diagnosed each year in the U.S., we need to use all available prevention strategies.” PrEP is one essential component in the nation’s high-impact prevention strategy
While PrEP can fill a critical gap in America’s prevention efforts, all available HIV prevention strategies must be used to have the greatest impact on the epidemic. These include treatment to suppress the virus among people living with HIV; correct and consistent use of condoms; reducing risk behaviors; and ensuring that people who inject drugs have access to sterile injection equipment from a reliable source.
“PrEP has the potential to dramatically reduce new HIV infections in the nation,” says Jonathan Mermin, M.D., M.P.H, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “However, PrEP only works if patients know about it, have access to it, and take it as prescribed.”
A separate analysis published in Vital Signs suggests that focused efforts can significantly expand the reach of PrEP. Researchers from the New York State Department of Health report that PrEP use among New Yorkers covered by Medicaid increased from 303 prescriptions filled from July 1, 2013, through June 30, 2014, to 1,330 prescriptions filled from July 1, 2014, through June 30, 2015 in the year following the launch of a statewide effort to increase PrEP knowledge among potential prescribers and candidates.
PrEP is one of four focus areas in the July 2015 Update to the National HIV/AIDS Prevention Strategy. Other key elements of the Strategy and the CDC’s high-impact prevention approach are:
- Widespread HIV testing and linkage to care that enables early treatment;
- Broad support for people living with HIV to remain engaged in comprehensive care, including support for treatment adherence;
- And universal viral suppression.
“Today’s prevention landscape is complex and with the wide range of strategies now available, no single tool addresses every prevention need. Reducing the toll of HIV in this nation will require matching the right tools to the right people,” said Eugene McCray, M.D., director of the CDC’s Division of HIV/AIDS Prevention. “Providers must work with patients to assess which tools best meet their needs. PrEP can benefit many who have high risk. Other risk reduction strategies, such as condoms and access to sterile injection equipment, also offer substantial protection when used consistently and correctly.”
In March, the CDC announced it is awarding up to $125 million in HIV prevention funding over three years to state and local health departments, in part to expand the use of PrEP for men who have sex with men (MSM). In July, the CDC announced it had awarded $216 million over five years to 90 community-based organizations (CBOs) nationwide to increase access to PrEP prevention and support services and other effective HIV prevention strategies among those at greatest risk, including men who have sex with men and people who inject drugs.
The CDC has also published resources to educate and advise providers – including 2014 clinical guidelines, step-by-step PrEP checklists and interview guides – and supports a hotline to answer providers’ questions about when and how to offer PrEP.
See the CDC Announcement
See the CDC’s Vital Signs Report
See also Medical Law Perspectives, May 2013 Report: Drugs, Dosage, and Damage: Physician Liability for Prescribing or Administering Medication