CDC: Physicians Need More Prep on HIV PrEP

Megan Brooks

November 24, 2015

Many Americans at high risk for HIV infection who could benefit from preexposure prophylaxis (PrEP) are not receiving it because many health providers do not know about it, federal health officials from the Centers for Disease Control and Prevention (CDC) said today.

The US Food and Drug Administration approved PrEP with oral antiretroviral medication for HIV prevention in 2012. When taken daily, it can reduce the risk for HIV acquired through sexual contact by more than 90%, and the risk for HIV acquired through injection drug use by more than 70%.

"PrEP isn't reaching many people who could benefit from it, and many providers remain unaware of its promise," CDC Director Tom Frieden, MD, said in a statement. "With about 40,000 HIV infections newly diagnosed each year in the US, we need to use all available prevention strategies."

"PrEP has the potential to dramatically reduce new HIV infections in the nation," added Jonathan Mermin, MD, director of 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."

According to a Vital Signs report published today by Dawn K. Smith, MD, from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, and colleagues in the Morbidity and Mortality Weekly Report, in 2014, roughly 24.7% (492,000) of sexually active gay and bisexual adult men, 18.5% (115,000) of adults who inject drugs, and 0.4% (624,000) of heterosexually active adults have "substantial risks" for acquiring HIV infection consistent with the 2014 US Public Health Service's PrEP clinical practice guideline.

 
Doctors need more prep about PrEP. Dr Anne Schuchat
 

Yet a recent study showed that about one third of primary care healthcare providers had "never heard of PrEP," Anne Schuchat, MD, CDC principal deputy director, noted during a press briefing. "The bottom line is, PrEP works, but doctors need more prep about PrEP," she said.

As previously reported by Medscape Medical News, updated CDC guidelines say PrEP should be considered for HIV-uninfected people with any of the following indications:

  • Anyone who is in an ongoing sexual relationship with an HIV-infected partner.

  • A gay or bisexual man who has had sex without a condom or has been diagnosed with a sexually transmitted infection within the past 6 months and is not in a mutually monogamous relationship with a partner who recently tested HIV-negative.

  • A heterosexual man or woman who does not always use condoms when having sex with partners known to be at risk for HIV (eg, injecting drug users or bisexual male partners of unknown HIV status) and who is not in a mutually monogamous relationship with a partner who recently tested HIV-negative

  • Anyone who has, within the last 6 months, injected illicit drugs and shared equipment or been in a treatment program for injection drug use.

In a separate Vital Signs report by Franklin N. Laufer, PhD, from the Office of Medicaid Policy and Programs, AIDS Institute, New York State Department of Health, New York City, and colleagues, also published today in the Morbidity and Mortality Weekly Report, the authors show that focused efforts can significantly expand the reach of PrEP, noted Eugene McCray, MD, CDC director of the Division of HIV/AIDS Prevention.

Researchers from the New York State Department of Health found that PrEP use among New Yorkers covered by Medicaid "increased substantially just a year after statewide efforts to increase PrEP knowledge among potential prescribers and candidates," he told reporters. San Francisco has also recently increased efforts around PrEP, with promising results. "While we can't credit this to PrEP alone, last year, San Francisco reported a record low of only 302 new HIV diagnoses compared to more than 2000 annually that were reported at the epidemic's peak," Dr McCray said.

"This type of effort needs to be replicated nationally, strategically scaling efforts and targeting the right people who stand to benefit the most," he added.

Dr McCray noted that in March, the CDC awarded up to $125 million in HIV prevention funding over the course of 3 years to state and local health departments, in part to expand use of PrEP for men who have sex with men. In July, the agency awarded $216 million over the course of 5 years to 90 community-based organizations nationwide to increase access to PrEP 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 resources on PrEP available to health providers, including 2014 clinical guidelines, step-by-step PrEP checklists, and interview guides. The CDC also supports a hotline to answer providers' questions about when and how to offer PrEP, Dr McCray noted.

Morb Mortal Wkly Rep. Published online November 24, 2015. Smith full text, Laufer full text

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