A new task force found the drug should be recommended to more people.
A federal proposal that urges doctors to prescribe a daily pill for all people with known risk factors for HIV could significantly raise awareness about an effective yet little used drug.
The proposed recommendations, recently released by the U.S. Preventive Services Task Force, concluded that pre-exposure prophylaxis (PrEP), a daily pill that helps prevent contracting HIV, can be effective for anyone who has sex with a partner who has the virus, anyone who has condomless sex with a partner whose status is unknown, and those who share injection drug or tattoo needles.
Separately, the task force also proposed that doctors screen patients who are 15 to 65 years old for HIV.
The U.S. Preventive Services Task Force, an independent, volunteer panel of national experts in disease prevention, released their draft of recommendation statements for public comment until Dec. 26, 2018.
Some public health officials and doctors say if approved, the recommendations will help expand the accessibility of PrEP to more people.
But health experts caution that disparities will continue to exist unless there are more frank discussions between patients and primary care doctors about sexual behavior and substance use.
“Very significant disparities exist in PrEP uptake, similar to the disparities we see across HIV,” said Gretchen Weiss, director for the HIV, STI and Viral Hepatitis division of the National Association of County and City Health Officials.
“The groups at highest risk for HIV are among the least likely to be on/prescribed PrEP and to maintain their PrEP regimen,” she added. “Closing this gap is absolutely the priority for PrEP implementation at a national level.”
Even though most health plans and Medicaid cover the drug, it remains underused and underprescribed. In 2012, the U.S. Food and Drug Administration (FDA) approved the drug for use. In 2016, the annual number of people using PrEP was reported to be about 78,360.
The task force’s proposed recommendations come a few months after a Centers for Disease Control and Prevention (CDC) study found that just a small percentage of Americans who could benefit from PrEP have been prescribed it.
In 2015, about 500,000 African-Americans and nearly 300,000 Latinos across the nation could’ve potentially benefited from PrEP based on CDC guidelines, CDC experts note in their study.
They found that 7,000 prescriptions were filled at retail pharmacies or mail-order services for African-Americans and 7,600 for Latinos from September 2015 to August 2016.
Of about 300,000 Caucasians who could’ve potentially benefited from PrEP, 42,000 prescriptions were filled at retail pharmacies or mail-order services, according to the study.
“To make a difference in the lives of people at high risk for HIV, clinicians need to identify patients who would benefit and offer them PrEP,” Dr. C. Seth Landefeld, a member of the task force, said in a statement.
The CDC estimates 1.1 million people live with HIV in the United States. Though the number of new HIV cases continue to decrease annually, rates among some groups are on the rise, especially among people ages 25 to 29, members of the task force note.
“About 40,000 people are diagnosed with HIV each year. This is why the task force, once again, calls for universal screening for HIV in adolescents and adults ages 15 to 65 years and in all pregnant women,” task force member Dr. John Epling, a professor of family and community medicine at the Virginia Tech Carilion School of Medicine in Roanoke, Virginia, said in a statement.
“People deserve to know their HIV status so, if needed, they can start treatment early and live long, healthy lives,” he added.
When it was first approved, PrEP was highly recommended for HIV-negative men who have sex with men living with HIV.
Since then, wider use has been encouraged by the CDC. In Los Angeles County, for example, public health officials recently launched a series of videos called “Sister Friends: Get PrEP’d” to increase use of the daily medication among women of color.
About 35 percent of women living with HIV in the county are black, 45 percent are Latina or Hispanic, and 30 percent are transgender women.
Epling says he believes more doctors are having those frank conversations with patients, especially in states where offering HIV screening is mandated.
But while getting the word out about PrEP is important, so too is the message that condoms still need to be used alongside the medication, Epling adds.
PrEP doesn’t prevent sexually transmitted diseases, which have been on a steady rise for the last several years, according to federal data.
While the list of individuals chosen by the task force who would benefit from PrEP is fair and inclusive, it’s just a start, said Whitney Engeran-Cordova, senior director of public health for AIDS Healthcare Foundation (AHF), a Los Angeles-based, nonprofit organization that provides HIV prevention services worldwide.
The reality is that taking a pill every day isn’t going to appeal to everyone.
“It’s clear now that PrEP works when people take it, but they have to take it every day,” Engeran-Cordova said. “It’s tough to ask people to do that. We’re seeing for sure that people are not taking PrEP every day, or not being consistent. That was kind of our big concern off the bat.”
Engeran-Cordova oversees clinics in 16 states for AHF. The agency recently secured a contract in Broward County, Florida, to offer PrEP at its clinics. So far, 800 clients seem interested, he says.
Instead of trying to encourage a community of people to take the drug, the solution may be to simplify the message.
“This is about one person and one doctor making a choice,” Engeran-Cordova said.