Johns Hopkins University Releases Academic Proposal to Improve Access to PrEP

The effective preventive treatment could reduce HIV rates but needs greater access and affordability, especially among Black and Latino populations, investigators contend.

Investigators at the Johns Hopkins Bloomberg School of Public Health have contributed to a special issue of the Journal of Law, Medicine, and Ethics, which included studies and commentary that support a national program to improve access to pre-exposure prophylaxis (PrEP), a medication to help prevent the spread of HIV.

Investigators at Johns Hopkins University, including the Bloomberg School, and national experts in HIV policy released the policy proposal for the national PrEP program in December 2021.

The proposal outlines a new delivery and financing system that moves away from expensive brand-name drugs and expands access points for PrEP for individuals who are Medicaid-covered, underinsured, and uninsured, underinsured.

“For more than a decade, PrEP has been available as a highly effective tool to curb the HIV epidemic, but it remains out of reach for many Americans,” Joshua Sharfstein, MD, vice dean of Public Health Practice and Community Engagement and professor of the practice in the Department of Health Policy and Management at the Bloomberg School, said in a statement.

“This is an issue of equity. Until we address the incredible gaps by income, race and ethnicity, age, and place, we will struggle to end the HIV epidemic,” Sharfstein said.

President Joseph R. Biden’s 2023 budget proposal, which was released in March 2022, includes $9.8 billion in funding over 10 years for a national PrEP program.

The academic proposal recommends that the government purchase PrEP medications to obtain a stable supply at a low price. Additionally, they recommend that clinicians have new options to provide onsite, same-day PrEP with improved access to laboratory testing.

They also recommended that individuals without regular health care should be able to access PrEP through community locations, such as domestic violence centers, street outreach programs, and telehealth.

The recommendations, which were published online on July 29, 2022, also include commentary and research papers addressing important considerations outlined in the policy proposal. The considerations include how to address Medicaid and private insurance coverage for PrEP, increasing access for vulnerable communities who are in most need of PrEP, and understanding how generic medications can offset financial burdens.

The results of 1 study included showed that generic medications offer a promising solution in addressing financial barriers to access. The investigators found that after generic PrEP was introduced to the market, the price per dose of the generic was just $1 compared with $28 for the branded PrEP. However, overall PrEP use did not appear to increase during the study period.

Another study in the recommendation showed that the national PrEP program could be modeled on other public health responses, such as the federal Vaccines for Children program, in which the government purchased vaccines for children covered by Medicaid or those who were uninsured.

Other studies in the proposal include international models of PrEP access, key implementation issues, pathways to increase access to laboratory services for PrEP, potential for partnerships with public health and the role of Medicaid.

Reference

Journal special issue offers evidence and guidance supporting National PrEP Program to turn tide on HIV. News release. EurekAlert. July 29, 2022. Accessed August 2, 2022. https://www.eurekalert.org/news-releases/960355