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Preventing Transmission through Use of HIV Medications

Access to comprehensive pre-exposure prophylaxis (PrEP) is a key component of the National HIV/AIDS Strategy. PrEP involves administering antiretroviral medications to HIV-negative individuals to prevent infection. In 2012, the U.S. Food and Drug Administration (FDA) approved Truvada® as the first drug to reduce the risk of transmitting HIV. Additional drugs are currently being studied for PrEP but have not yet been approved by the FDA. To diminish the risk of infection, HIV-negative individuals can take this oral antiretroviral medication daily. When taken as prescribed, PrEP is highly effective in reducing the risk of HIV infection and is even more effective when used in conjunction with condoms and other prevention strategies.

When people know they have been exposed to the HIV virus, post-exposure prophylaxis (PEP), or antiretroviral medications, have also been shown to reduce the risk of HIV. PEP may be used in non-occupational settings when a person has an unprotected sexual encounter with an HIV-positive person or may be used in occupational settings, such as when a healthcare worker is stuck with a needle used on an HIV-positive patient. The PEP regimen must be initiated within 72 hours after possible exposure to HIV, though beginning the medication sooner is more effective in preventing HIV.

Examples of Rural Programs Using HIV Medications to Prevent Transmission:

  • Health Services Center is a community-based organization in Alabama that offers PrEP services to their patients as a preventive method for those at high risk of HIV. Along with providing PrEP medications free of charge, the Health Services Center also continually monitors patients on a PrEP regimen, educates patients about important HIV prevention strategies, and tests for other sexually transmitted infections prior to starting a patient on PrEP.
  • The Colorado Health Network (CHN) utilized a funding opportunity offered through the Colorado Department of Public Health and Environment Public Health Improvement Plan, which aims to improve access to PrEP drugs for high-risk individuals. CHN used these funds to hire additional clinicians and office staff dedicated to work solely with PrEP patients.
  • The Dakotas AIDS Education and Training Center (DAETC) works with 10 community health centers in the Dakotas to educate healthcare providers about HIV treatment and prevention methods for their largely rural and tribal populations. The center recently shared a webinar on incorporating PrEP and PEP medications into existing HIV prevention and treatment models for their member clinics.

Considerations for Implementation

Pre-exposure prophylaxis (PrEP) is an increasingly important strategy being recommended for the prevention of HIV. Cultural barriers, a lack of community knowledge about PrEP, and access to care barriers especially in rural locations all are factors that need to be considered when implementing a program that will utilize PrEP. PrEP is a medication that needs to be prescribed by a doctor in a clinical setting, which can also be a challenge in some communities.

Administering post-exposure prophylaxis (PEP) within the 72-hour time period is a key part of the HIV prevention strategy for this medication. As such, it is important that people are aware of the limited time period available to use PEP.

Some states may have developed strategies and programs to help subsidize or fully cover the cost of PrEP and PEP medications. For example, New York has implemented a plan to help reimburse individuals who quality for these medications. Many insurance plans also fully cover the cost of these drugs; however, people should be aware about insurance coverage policies prior to initiating these regimens since these medications can be costly and some insurance plans have limitations. In cases where a patient's health insurance does not cover the full cost, the manufacturers of the PEP and PrEP drugs also have their own medication assistance program. For victims of sexual assault, the U.S. Department of Justice's Office for Victims of Crime may reimburse some or all costs associated with PEP. For healthcare workers exposed to HIV, workers' compensation likely also covers all costs of PEP.

Resources to Learn More

HIV Basics: PrEP
Website
Provides information for the general public about PrEP, including medication assistance resources and general clinical recommendations. Also includes infographics that may be useful to individuals or agencies looking for communications materials about PrEP.
Organization(s): Centers for Disease Control and Prevention

Preexposure Prophylaxis for the Prevention of HIV Infection in the United States – 2014: A Clinical Practice Guideline
Document
Guidelines about the use of pre-exposure prophylaxis (PrEP) and how it can help providers more accurately determine patient risk for HIV infection. Also provides background information about clinical trials that established safety and efficacy of the PrEP regimen.
Organization(s): Centers for Disease Control and Prevention
Date: 2014

PrEP and Local Health Departments Educational Series
Tutorial/Training
Educational series aimed at increasing knowledge of local health departments and building awareness of how to use and implement PrEP (Pre-Exposure Prophylaxis) for HIV prevention. Also discusses the role that local health departments can play in delivering and supporting PrEP for HIV prevention.
Organization(s): National Association of County and City Health Officials (NACCHO)

PrEParing Latinos for HIV Prevention
Document
Provides information about the impact of the HIV epidemic on the Latino community. Also describes how PrEP can be used to prevent new infections and the challenges faced in accessing treatment in rural communities.
Author(s): Zaldivar, R.
Organization(s): AIDS Community Research Initiative of America
Date: 2/2016

We Have the Tools to End HIV: Benefits, Barriers, and Solutions to Expanded Utilization of Pre-exposure Prophylaxis (PrEP) in the US Deep South
Document
Describes the high prevalence of HIV/AIDS in the Southeastern portion of the United States and provides an overview of barriers towards PrEP usage in this region. Also provides potential methods to overcome these PrEP challenges.
Organization(s): Southern HIV/AIDS Strategy Initiative
Date: 6/2016