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CDC Vital Signs Show Need For Increased Awareness of PrEP

by Winnie McCroy
EDGE Editor
Wednesday Dec 9, 2015

A new Vital Signs report shows that nearly 20 percent of adults who inject drugs, and less than 1 percent of heterosexually active adults are at substantial risk for HIV infection and should be counseled about PrEP, a daily pill for HIV prevention.

"The CDC recommended PReP as one of several effective actions for reducing the risk of HIV infection. It's a daily pill for people at substantial risk for contracting HIV," said CDC Principal Deputy Director Anne Schuchat, M.D., in a telefconference. "When taken daily, PrEP can reduce your risk by 90 percent for sex and 70 percent for IDUs. A growing body of research shows that PrEP is incredibly effective when taken consistently."
 
PrEP for HIV prevention was approved by the Food and Drug Administration in 2012. When taken daily, it can reduce the risk of sexually acquired HIV by more than 90 percent. Daily PrEP can also reduce the risk of HIV infection among people who inject drugs by more than 70 percent. However, according to recent studies, some primary health care providers have never heard of PrEP. Increasing awareness of PrEP and counseling for those at substantial risk for HIV infection is critical to realizing the full prevention potential of PrEP.
 
"PrEP isn't reaching many people who could benefit from it, and many providers remain unaware of its promise," said CDC Director Tom Frieden, M.D., M.P.H. "With about 40,000 HIV infections newly diagnosed each year in the U.S., we need to use all available prevention strategies."

"The bottom line is, doctors need more prep about PrEP," said Schuchat. "We recognize that clinicians are working in a highly complex prevention landscape, but all tools should be used."
  
These include treatment to suppress the virus among people living with HIV; correct and consistent use of condoms; reducing risk behaviors; and ensuring people who inject drugs have access to sterile injection equipment from a reliable source.


A survey of doctors from 2015 estimates that 34 percent are not aware of PrEP. And although 2/3 of doctors are aware of it, that doesn't necessarily mean they are comfortable prescribing it. As it's a fairly new intervention, Vital Signs is issuing tools to make it easier to learn how to prescribe and talk about PrEP.

Jonathan Mermin, M.D., M.P.H, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said that PrEP was a powerful tool, but only if patients received it. Right now, we only have 30 percent viral suppression. It's important that clinicians begin discussing behavioral risks and identify those who could benefit from more information about PrEP.
 
"PrEP has the potential to dramatically reduce new HIV infections in the nation," said Mermin. "However, PrEP only works if patients know about it, have access to it, and take it as prescribed."
 
A separate analysis published in Vital Signs suggests that focused efforts can significantly expand the reach of PrEP. Researchers from the New York State Department of Health report that PrEP use among New Yorkers covered by Medicaid increased from 303 prescriptions filled from July 1, 2013-June 30, 2014, to 1,330 prescriptions filled from July 1, 2014-June 30, 2015 in the year, following the launch of a statewide effort to increase PrEP knowledge among potential prescribers and candidates.

The CDC has published resources to educate and advise providers -- including 2014 clinical guidelines, step-by-step PrEP checklists and interview guides -- and supports a hotline to answer providers' questions about when and how to offer PrEP.


PrEP is one of four focus areas in the July 2015 Update to the National HIV/AIDS Prevention Strategy. Other key elements of the Strategy and CDC's high-impact prevention approach are:
 

  • Widespread HIV testing and linkage to care that enables early treatment;
  • Broad support for people living with HIV to remain engaged in comprehensive care, including support for treatment adherence;
  • And universal viral suppression.
     
    Eugene McCray, M.D., director of CDC's Division of HIV/AIDS Prevention, said that matching to right tools to the right people was vital. While they continue to scale up prevention strategies, like consistent condom use and education, PrEP should be viewed as another tool for some who are at risk.

    "Today's prevention landscape is complex and with the wide range of strategies now available, no single tool addresses every prevention need. Reducing the toll of HIV in this nation will require matching the right tools to the right people," said McCray. "Providers must work with patients to assess which tools best meet their needs. PrEP can benefit many who have high risk. Other risk reduction strategies, such as condoms and access to sterile injection equipment, also offer substantial protection when used consistently and correctly."
     
    McCray noted that in a separate analysis in Vital Signs, PrEP use rose among New Yorkers dramatically in the year after Medicaid began to offer it. The same results were found in Canada, where PrEP came at no charged to the uninsured beginning in 2013. And in San Francisco, 15 percent of gay men are not on PrEP, resulting in a reported record low of only 302 new HIV diagnoses, compared to 2,000 annually at the epidemic's peak.

    In March, CDC announced it is awarding up to $125 million in HIV prevention funding over three years to state and local health departments, in part to expand the use of PrEP for men who have sex with men (MSM). In July, CDC announced it had awarded $216 million over five years to 90 community-based organizations (CBOs) nationwide to increase access to PrEP prevention and support services and other effective HIV prevention strategies among those at greatest risk, including men who have sex with men and people who inject drugs.

    "These efforts need to be replicated nationally," said McCray. "We are strategically finding the people who most benefit from PrEP, and the CDC is working on many fronts so people know about PrEP and can access it if they want to."


    Winnie McCroy is the Women on the EDGE Editor, HIV/Health Editor, and Assistant Entertainment Editor for EDGE Media Network, handling all women's news, HIV health stories and theater reviews throughout the U.S. She has contributed to other publications, including The Village Voice, Gay City News, Chelsea Now and The Advocate, and lives in Brooklyn, New York.


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