As part of comprehensive efforts to reduce the number of new HIV infections, some states are innovating to make HIV pre-exposure prophylaxis (PrEP) more accessible to individuals at high risk of HIV.
PrEP's Potential to Help Reach National Goal for Reducing New HIV Infections
PrEP is a highly effective HIV prevention strategy that involves taking a once-daily pill that can reduce the risk of acquiring HIV in HIV-negative individuals. PrEP can stop HIV from taking hold and spreading throughout your body. It is highly effective for preventing HIV if used as prescribed. (Read more about PrEP in HIV.gov's HIV Basics section.)
The National HIV/AIDS Strategy (NHAS) calls for improving access to PrEP. When the NHAS was updated in 2015, it identified four key areas of critical focus between 2015 and 2020, including "full access to comprehensive PrEP services for those whom it is appropriate and desired, with support for medication adherence for those using PrEP."
Underscoring the potential benefit of scaled up use of PrEP, researchers from Emory University and CDC presented their analysis at AIDS 2018 that PrEP uptake in 38 states and the District of Columbia was significantly associated with declines in HIV diagnoses between 2012 and 2016 and that this association is independent of levels of viral suppression among people living with HIV. (Read the abstract.)
However, earlier this year CDC shared analysis that highlighted one of the key obstacles to achieving the full potential of PrEP: only a small percentage of Americans who could benefit from PrEP have been prescribed it. That analysis found that while two-thirds of people who could potentially benefit from PrEP are African-American or Latino, they account for the smallest percentage of prescriptions to date. (Read the CDC news release about this analysis; view our interview with CDC's Dr. Dawn Smith who discussed the study with us from CROI 2018. A subsequent analysis of PrEP use by race and ethnicity was published by CDC in October 2018.)
These analyses clearly illustrate the need for more and innovative approaches to improve awareness, access, and adherence to this powerful HIV prevention tool. Several states have already undertaken such efforts.
Florida Offers PrEP for Free
The Florida Department of Health is making PrEP available at no cost at all of the state's 67 county health departments. It is already available in many of the health departments and by the end of 2018 it should be available in all of them.
"Ensuring PrEP to those at highest risk for HIV infection, regardless of their ability to pay, is one of the four key components of the [state health department's] plan to eliminate HIV transmission and reduce HIV-related deaths," Mara Gambineri, a spokesperson for the department, said in a statement.
Patients requesting PrEP must first be evaluated clinically—a process that includes an HIV test, hepatitis C test, and a liver function test. Patients also receive education on the drug, a prescription of PrEP medications, and a 3-month follow-up after PrEP initiation. Although the prescription for the drug is free, there is a fee for the evaluation. Patients will be charged on a sliding scale based on income eligibility.
The state announced their PrEP initiative on World AIDS Day 2017, noting that this effort is one of four key strategies being pursued by the state health department to make an even greater impact on reducing HIV rates in Florida.
Iowa Deploys Telemedicine to Improve PrEP Access in Rural Communities
People in rural communities in Iowa who are at high risk of HIV now have access to PrEP through the state's innovative telehealth program. For the last year, the University of Iowa-led TelePrEP program has expanded access to PrEP by using secure video conferencing for in-home visits between patients and UI Health Care pharmacists and providers.
Patients visit with a pharmacist using a secure HIPAA-compliant app on a smartphone, laptop, or tablet. Lab tests can be obtained locally by visiting an outpatient lab site or utilizing Iowa's extensive network of public health providers. Qualified patients then receive medication delivery by mail. The service also helps patients navigate these steps
Acknowledging the lack of PrEP prescribers in many rural communities across the country, the TelePrEP website states, "We believe that every Iowan who wants/needs PrEP should be able to get it without having to spend a whole day in the car and without risking a loss of privacy."
"We know that there are people in rural Iowa who are at risk for HIV. Approaches that work well for delivering PrEP in large cities don't adapt to rural Iowa. We need to try different approaches such as this telehealth technology to make sure PrEP is available to those who need it, regardless of where they live," said Michael Ohl, MD, a UI Health Care infectious disease specialist and medical director of the TelePrEP service.
Funded by the Iowa Department of Public Health, the TelePrEP service is a collaborative effort among the Department, the Signal Center for Health Innovation, the Johnson County Public Health, and the UI Health Care Departments of Infectious Disease and Pharmaceutical Care. Visit the TelePrEP program's website to learn more.