Study: Adherence to PrEP Increases Prevention of HIV

Pre-exposure prophylaxis (PrEP) helps prevent HIV, with 100% efficacy among individuals who adhere well to treatment.

However, the lack of access and awareness about PrEP, medication cost, and underestimating HIV risk are all barriers.

The stigma and structural inequities in education about PrEP can help close the gaps, according to investigators of a study, published in the Canadian Medical Association Journal

Health care providers can help facilitate more access by advocating for systemic changes, learning more about PrEP, and starting more conversations with patients to destigmatize the therapy, , investigators said.

In the study, investigators stated that results from various observational studies, and randomized controlled trials showed that daily use of PrEP was almost 100% effective among bisexual, gay, and other men who have sex with men (GBM), when adherence was high.

Additionally, depending on adherence, the efficacy of PrEP was as high as 95% for heterosexual exposure, according to the study results.

The indication for PrEP is based on the likelihood of high-risk exposure to transmissible HIV, which includes HIV-positive with viral load of greater than 40 copies/mL, when HIV status is unknown but from a population with high HIV prevalence, investigators said.

In addition, high-risk exposure from HIV-positive sources includes needle sharing and receptive anal intercourse.

Additionally, recommendations for PrEP should take into consideration the individual’s risk factors and local epidemiology and should include shared decision-making between patients and their physicians, investigators said.

Investigators emphasized that individuals should not be denied PrEP if they self-identify as high risk outside the recommendations.

Because most efforts to increase usage of PrEP in Canada, as well as other countries, have focused largely on GBM, other groups at risk for HIV, such as individuals who inject drugs and women, have been underappreciated.

Even for those who do have an elevated risk, acceptability and low awareness about PrEP have contributed to the lower rates of those in high-risk groups receiving the therapy, investigators said.

For example, GBM who are considered “less out” or do not identify as gay have been linked to discomfort with disclosure of their sexual orientation out of fear that PrEP will “out” them and less PrEP awareness and knowledge.

Additionally, other individuals, including those who are Black and Indigenous, have been associated with less awareness and knowledge of PrEP, according to the investigators.

To address these barriers, the investigators recommend that physicians should start discussions round HIV and PrEP as part of routine preventative health care.

PrEP should be considered standard care for those who have bacterial sexually transmitted infections (STIs) or those undergoing STI testing, investigators said.

These conversations provides a safe space for patients and physicians to discuss HIV and PrEP to combat the stigma around sexual orientation and substance use disorder.

Physicians should further educate themselves about these topics to help facilitate these conversations with patients, and technology can be used to increase access to PrEP for patients, investigators said.

Reference

Hempel A, Biondi MJ, Baril J, Tan DHS. Pre-exposure prophylaxis for HIV: effective and underused. CMAJ. 2022;194(34)E1164-E1170. doi:10.1503/cmaj.220645