Open AccessAntiretroviral pre‐exposure prophylaxis implementation in the United States: a work in progress
Author(s) -
Mayer Kenneth H,
Hosek Sybil,
Cohen Stephanie,
Liu Albert,
Pickett Jim,
Warren Mitchell,
Krakower Douglas,
Grant Robert
Publication year - 2015
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.18.4.19980
Subject(s) - medicine , pre exposure prophylaxis , underinsured , emtricitabine , family medicine , psychological intervention , best practice , human immunodeficiency virus (hiv) , health care , environmental health , men who have sex with men , health insurance , nursing , antiretroviral therapy , viral load , economic growth , management , syphilis , economics
After the initial approval of the use of tenofovir disoproxil fumarate‐emtricitabine (TDF/FTC) by the US Food and Drug Administration in 2012 for anti‐HIV pre‐exposure prophylaxis (PrEP), uptake was initially limited, but more recent community surveys and expert opinion suggest wider acceptance in some key populations. Discussion Demonstration projects are underway to determine the best practices in the United States to identify at‐risk individuals in primary care and sexually transmitted disease clinics who could benefit from PrEP. Studies of PrEP in combination with behavioural interventions are being evaluated. Studies to evaluate the use of PrEP by HIV‐uninfected women in HIV‐discordant couples interested in safe conception are also getting underway. The optimal deployment of PrEP as part of a comprehensive national HIV/AIDS strategy in the United States has been limited by lack of knowledge among some at‐risk people and by some medical providers indicating that they do not feel sufficiently knowledgeable and comfortable in prescribing PrEP. Studies are underway to determine how to assist busy clinicians to determine which of their patients could benefit from PrEP. Although most federal health insurance programmes will cover most of the costs associated with PrEP, underinsured patients in states that have not enacted health reform face additional challenges in paying for PrEP medication and appropriate clinical monitoring. Conclusions PrEP implementation in the United States is a work in progress, with increasing awareness and uptake among some individuals in key populations.