Abstract
IntroductionAfter the initial approval of the use of tenofovir disoproxil fumarate-emtricitabine (TDF/FTC) by the US Food and Drug Administration in 2012 for anti-HIV pre-exposure prophylaxis (PrEP), uptake was initially limited, but more recent community surveys and expert opinion suggest wider acceptance in some key populations.DiscussionDemonstration projects are underway to determine the best practices in the United States to identify at-risk individuals in primary care and sexually transmitted disease clinics who could benefit from PrEP. Studies of PrEP in combination with behavioural interventions are being evaluated. Studies to evaluate the use of PrEP by HIV-uninfected women in HIV-discordant couples interested in safe conception are also getting underway. The optimal deployment of PrEP as part of a comprehensive national HIV/AIDS strategy in the United States has been limited by lack of knowledge among some at-risk people and by some medical providers indicating that they do not feel sufficiently knowledgeable and comfortable in prescribing PrEP. Studies are underway to determine how to assist busy clinicians to determine which of their patients could benefit from PrEP. Although most federal health insurance programmes will cover most of the costs associated with PrEP, underinsured patients in states that have not enacted health reform face additional challenges in paying for PrEP medication and appropriate clinical monitoring.ConclusionsPrEP implementation in the United States is a work in progress, with increasing awareness and uptake among some individuals in key populations.
Highlights
After the initial approval of the use of tenofovir disoproxil fumarate-emtricitabine (TDF/FTC) by the US Food and Drug Administration in 2012 for anti-HIV pre-exposure prophylaxis (PrEP), uptake was initially limited, but more recent community surveys and expert opinion suggest wider acceptance in some key populations
Several studies are underway in the United States, as well as internationally, that may have an impact on how PrEP is delivered over the few years [36]
In October 2014, the British PROUD open-label oral TDF/FTC PrEP demonstration project determined that men who have sex with men (MSM) assigned to receive PrEP had an 86% decrease in their risk of becoming HIV-infected compared to participants assigned to the waiting-list condition [37]
Summary
Kenneth H, Sybil Hosek, Stephanie Cohen, Albert Liu, Jim Pickett, Mitchell Warren, Douglas Krakower, and Robert Grant. 2015. Kenneth H, Sybil Hosek, Stephanie Cohen, Albert Liu, Jim Pickett, Mitchell Warren, Douglas Krakower, and Robert Grant. “Antiretroviral pre-exposure prophylaxis implementation in the United States: a work in progress.”. Journal of the International AIDS Society 18 (4Suppl 3): 19980. Kenneth H Mayer§,1,2,3, Sybil Hosek, Stephanie Cohen, Albert Liu, Jim Pickett, Mitchell Warren, Douglas Krakower and Robert Grant
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