Analysis: Federal HIV/AIDS Goal Achievable with Just 25% PrEP Uptake

Brianne Olivieri-Mui, MPH, a PhD candidate at Northeastern and a co-author of the study

Brianne Olivieri-Mui, MPH

A new study based on computer simulation models shows that the US could achieve 1 of its key 2020 National HIV/AIDS Strategy goals if just one-quarter of men who have sex with men started taking a daily preventative prophylaxis.

The study shows the potent power of Pre-Exposure Prophylaxis (PrEP), and provides a ray of opportunity even as many worry the US is on pace to fall short of the national HIV/AIDS goals.

Researchers from Drexel University and Northeastern University used a model based on 10,000 high-risk male patients who have sex with men (MSM). The model looked at the statistical impact of PrEP use under 8 different scenarios, including PrEP alone, and PrEp alongside other strategies, such as condom use, treatment-as-prevention (TasP), and seroadaptive behavior.

The model showed that, even absent of any other strategies, PrEP use by 25% of MSM would prevent 30.7% of HIV infections. That figure would be enough to surpass the nation’s overall goal of reducing HIV infections by 25% by 2020.

Absent of PrEP, condom use prevented 48.8% of infections, seroadaptive behaviors prevented 37.7% of infections, and TasP prevented 27.1% of infections. If all of those strategies were used, 72.2% of new infections would be stopped, the model showed.

While those numbers are encouraging, the study’s authors noted that uptake of PrEP, which is sold under the brand name Truvada, remains relatively low.

Brianne Olivieri-Mui, MPH, a PhD candidate at Northeastern and a co-author of the study, said greater awareness and education among patients, physicians, and pharmacists would help increase use of PrEP. She told MD Magazine that there’s a role for government to play to raise awareness and boost access.

“Wide reaching campaigns and information dissemination efforts might work to combat this, especially since many providers are willing to learn about and prescribe PrEP,” she said. “To this end, local level changes can include leveraging social and provider networks as well as community organizations to spread PrEP education.”

At the state and federal level, Olivieri-Mui suggested officials could make PrEP education and counseling mandatory for any facility receiving federal funding.

“These tactics have been effective in disseminating information on other health care areas,” she said, “however education does not assuage costs. Insurance coverage of PrEP varies widely and, for the uninsured, costs are prohibitively expensive.”

Olivieri-Mui said some patients report costs of $1,600 per month for PrEP, and others pay more than $10,000 per year. She said some programs exist to provide lower-cost access, but those programs can be difficult for patients to locate.

The federal government’s PrEP Framework offers strategies for federal agencies to help improve access to PrEP, and there have been efforts at the state and local level to close the access gap, including a website designed to help patients compare PrEP coverage between multiple insurance marketplace plans.

Olivieri-Mui said there’s clearly political will behind efforts to improve PrEP uptake, though she said other initiatives by the current administration could be detrimental to access, leaving unclear the question of whether all levels of government are fully committed to the goal.

Internationally, however, there is a more unified effort. The World Health Organization and the Joint United Nations Program on HIV/AIDS have both taken the lead, and countries such as South Africa and Brazil have launched dedicated programs to boost PrEP access as a means of reducing HIV transmission.

The study is published in the January 2018 edition of the Journal of Acquired Immune Deficiency Syndromes.