Not Enough Patients Are on PrEP: How Primary Care Physicians Can Help
The HIV risk conversation can be difficult to initiate, but Dr. Englund suggests treating it like any other routine, preventative question.
An estimated 1.1 million persons aged 13 and older are living with HIV infection in the United States, according to the most recent data from the Centers for Disease Control and Prevention (CDC). That number includes an estimated 162,500 (15 percent) who are undiagnosed. Physicians diagnose about 38,000 new patients each year.
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Pre-Exposure Prophylaxis (PrEP) is critical to stopping the spread of HIV. Taken daily, it can reduce the risk of acquiring HIV by 77 to 90 percent. The single tablet contains two separate antiretroviral agents and is prescribed after screening a patient for symptoms of HIV and checking labs for HIV, other sexually transmitted infections and kidney function. These tests must be repeated every three months to remain on PrEP. Most insurance companies cover the cost of the prescription and labs, and the Gilead Advancing Access® program can cover copays.
“Unfortunately, only about 78,000 people have been put on PrEP to date,” says Kristin Englund, MD, staff physician, Department of Infectious Disease. “There are commercials, billboards and flyers advertising PrEP, but patients care about what their physicians recommend. More physicians need to talk to their patients about PrEP and do so in a way that increases use of this important drug.”
The HIV risk conversation can be difficult to initiate, but Dr. Englund suggests treating it like any other routine, preventative question. “A patient may not want to disclose or discuss at-risk behaviors, but this conversation is an important step in protecting your patients’ overall health. The main goal is to let patients know we want to keep them safe from HIV.”
Dr. Englund says this starts by understanding who’s at risk. The Centers for Disease Control (CDC) offers helpful fact sheets for providers that detail patients most at risk as well as a customizable risk reduction tool to share with patients during the discussion. The CDC also runs a campaign to increase provider awareness of how and when to use the drug and offers online CME.
Cleveland Clinic offers virtual visits for the three-month follow-up to encourage patient adherence, and patients can have labs drawn at any Cleveland Clinic lab. “Our infectious disease team is doing everything we can to make information and medication available and to increase access,” says Dr. Englund. “We’re very pleased to have a virtual site for PrEP. Now, we as physicians just need to work harder to let our patients know it’s a viable, safe, important option.”