Evolving Models and Ongoing Challenges for HIV Preexposure Prophylaxis Implementation in the United States.

View Abstract

BACKGROUND

The use of preexposure prophylaxis (PrEP) for HIV prevention was approved by the Food and Drug Administration in 2012, but delivery to at-risk persons has lagged. This critical review analyzes the current state of PrEP implementation in the United States, by reviewing barriers and innovative solutions to enhance PrEP access and uptake.

SETTING

Clinical care settings, public health programs, and community-based organizations (CBOs).

METHODS

Critical review of recent peer-reviewed literature.

RESULTS

More than 100 papers were reviewed. PrEP is currently provided in diverse settings. Care models include sexually transmitted disease clinics, community health centers, CBOs, pharmacies, and private primary care providers (PCPs). Sexually transmitted disease clinics have staff trained in sexual health counseling and are linked to public health programs (eg, partner notification services), whereas PCPs and community health centers may be less comfortable counseling and feel time-constrained in managing PrEP. However, PCPs may be ideal PrEP providers, given their long-term relationships with patients, integrating PrEP into routine care. Collaborations with CBOs can expand PrEP care through adherence support and insurance navigation. Pharmacies can deliver PrEP, given their experience with medication dispensing and counseling, and may be more accessible for some patients, but to address other health concerns, liaisons with PCPs may be needed.

CONCLUSIONS

PrEP implementation in the United States is moving forward with the development of diverse models of delivery. Optimal scale-up will require learning about the best features of each model and providing choices to consumers that enhance engagement and uptake.

Investigators
Abbreviation
J. Acquir. Immune Defic. Syndr.
Publication Date
2018-02-01
Volume
77
Issue
2
Page Numbers
119-127
Pubmed ID
29084044
Medium
Print
Full Title
Evolving Models and Ongoing Challenges for HIV Preexposure Prophylaxis Implementation in the United States.
Authors
Mayer KH, Chan PA, R Patel R, Flash CA, Krakower DS