It is estimated that 40,000 new HIV infections are diagnosed each year, and the key to dramatically reducing the number of such infections may be something as simple as health care provider education. A daily pill is available that can be used as pre-exposure prophylaxis (PrEP) to significantly lower the risk of acquiring the HIV infection for certain individuals, yet the Centers for Disease Control and Prevention (CDC) says that one in three primary care physicians and nurses have not heard about the drug. A CDC report estimates that 25 percent of sexually active gay and bisexual adult men, almost 20 percent of intravenous drug users, and about one percent of sexually active heterosexual adults are at a substantial risk for HIV infection and should receive counseling about the availability of PrEP, which, if taken daily, could prevent HIV infections.
In 2012, the FDA approved Truvada®, which is a as daily pill used to prevent new HIV infections. Truvada is currently the only drug approved by the FDA to be used as PrEP. The CDC estimates that the drug can reduce the risk of sexually acquired HIV by over 90 percent when taken daily. It can also reduce the risk of infection for intravenous drug users by over 70 percent. However, the CDC found that one in three primary health care providers and nurses do not know about PrEP. Therefore, the CDC states that it is critical to raise awareness of PrEP and counseling for high-risk individuals in order to reduce new infections.
CDC Director Tom Frieden, M.D., said, “PrEP isn’t reaching many people who could benefit from it, and many providers remain unaware of its promise.” Frieden also stated, “With about 40,000 HIV infections newly diagnosed each year in the U.S., we need to use all available prevention strategies.”
While PrEP is one of the four focus areas of the 2015 National HIV/AIDS Strategy for the United States, the CDC notes that all currently available prevention strategies, such as viral suppression treatment, consistent condom usage, reduction of risky behaviors, and accessibility to sterile drug injection equipment must be implemented in order to make an impact on the epidemic. Other focus areas of the prevention strategy include widespread HIV testing and access to care for early treatment, board support for those with HIV to ensure that they remain in treatment, and a focus on universal viral suppression.
New York Efforts
A separate study performed by the New York State Department of Health found that the reach of PrEP can be significantly expanded by focusing efforts on its use. Researchers reported that the use of PrEP by New York residents who were covered by Medicaid increased from just 303 filled prescriptions during a period from July 2013 to the end of June 2014, to 1,330 filled prescriptions filled during the following year. The increase in the filled prescriptions occurred after the launch of a statewide effort to work with prescribers and candidates to increase knowledge about PrEP.
The CDC is awarding up to $125 million for HIV prevention funding to state and local health departments over the next three years. One of the goals of the increased funding is to expand the use of PrEP for men who have sex with other men (MSM). The CDC also announced that it has awarded $216 million over five years to 90, community-based organizations across the country in the attempt to increase access to PrEP and to fund other HIV prevention strategies for individuals who are at the greatest risk of infection.
In addition to the increased funding, the CDC published educational resources for providers, such as the 2014 PrEP clinical practice guidelines, interview guidelines, and “step-by-step” checklists for prescribing PrEP. The CDC also supports a hotline that answers any questions for providers in offering PrEP.