New PrEP medication recommendation adds options for HIV patients

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Nationwide, an estimated 1.2 million people are eligible to receive medication that can prevent the spread of life-threatening HIV infection. But only roughly a third of those eligible are currently accessing preexposure prophylaxis, or PrEP, which is seen as key to eventually ending the HIV epidemic in the United States.

A set of new recommendations from the U.S. Preventive Services Task Force endorsed two additional medications approved for PrEP: an oral medication and a long-acting injectable, choices that could help narrow existing disparities and enhance access, particularly in communities of color.

“PrEP is the ultimate implementation science challenge,” the task force wrote in the journal JAMA. “At more than 90 percent efficacy when used properly, the only barrier to drastically reducing HIV incidence in the U.S. is addressing the systemic low coverage.”

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Graphic by Megan McGrew/PBS NewsHour

Some people prefer to take PrEP as one more pill they take daily, especially if they are needle-averse, said Dr. John Wong, a task force member and a primary care clinician at Tufts Medical Center. But for others, an injection of PrEP medication once every two months may make more sense.

“PrEP is a safe and highly effective way to prevent HIV for people with increased risk,” Wong said. “The good news is we have two new ways to take PrEP.”

In 2019, the task force gave the first oral PrEP medication an A grade, which often acts as a signal to health insurance companies to cover well-vetted medications without asking patients for out-of-pocket costs, Wong said. Since then, the Food and Drug Administration has approved two new forms of the medication – an additional oral form as well as a long-acting injectable formulation. When crafting recommendations, the task force does not consider insurance coverage and instead strictly weighs harms and benefits of a medical intervention, such as a medication or preventative screening. However, the Affordable Care Act compels private insurance companies to cover preventive services that receive the task force’s A or B grade recommendations.

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Chart by Megan McGrew/PBS NewsHour

Despite the medical confidence backing this treatment, people’s willingness and awareness of PrEP and its potential might be shaped by an historic lack of trust in the health care system and mistreatment by health care providers, Wong said. Fear of stigma also prevents people from taking full advantage of this medication.

Among people who are eligible to receive PrEP, 78 percent of white people already had begun taking this medication by 2021, according to federal data. By comparison, only 11 percent of Black people who are eligible to take PrEP had started.

This discrepancy may be especially pronounced for vulnerable populations, including people who are unhoused or who are struggling with substance use, as well as people whose work situations make getting a prescription refill logistically difficult, said Carl Schmid, executive director for the HIV+Hepatitis Policy Center.

The task force stressed that the medical community must devote greater efforts to relaying its safety and effectiveness, as well as to explore ways to overcome barriers to access.

“People seeking PrEP must not face any additional barriers as they seek to access the form of PrEP that best meets their individual needs,” Schmid said.

Correction: This story has been updated to clarify who is eligible for PrEP; the medication is for people who do not yet have HIV/AIDS.

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