Pre-Exposure Prophylaxis (PrEP) for HIV Prevention: A Clinical Practice Review

Ng, Yeow Chye

Background: Primary care providers should possess current, evidenced-based knowledge in order to provide competent and compassionate patient care. According to research evidence, there is a wide variance with respect to HIV/AIDS knowledge, attitudes, and behaviors among healthcare providers. Unfortunately, knowledge deficits and preconceived ideas may create major barriers for HIV-positive patients seeking care. Due to the recent availability of PrEP medication guidelines, nurse practitioners should expect more patients to present to clinical sites, requesting information on HIV prevention and treatment modalities measures. In fact, a recent nurse practitioner conference survey showed that 85% of providers were unaware of the 2014 Clinical Practice Guidelines for the PrEP program and agreed that the new guidelines would present several challenges due to lack of standardization.

Methods: A review of the literature was conducted on PrEP articles published between 2011 and 2014 from four major organizations: Centers for Disease Control and Prevention (CDC), United States Food and Drug Administration (FDA), New York State Department of Health, AIDS Institute (NYSDOH), and the United States Public Health Service (USPHS).

Findings: In 2011, CDC released an interim guidance titled PrEP for Men who have Sex with Men (MSM). July 2012, FDA approved two combination drugs (TDF/FTC) for PrEP treatment. August 2012, CDC released another interim guidance on PrEP program for heterosexuals. June 2013, CDC further expands the guidance on PrEP program for Injecting Drug User (IDU) population. January 2014, the NYSDOH released an online guidance for PrEP program. May 2014, USPHS officially published the first clinical practice guideline for PrEP program. Recommendations from these organizations were synthesized, based on appropriate clinical practice guidelines for advanced practice nurses.

Summary/Implications for Practice: Primary prevention is unmistakably the solution to reducing the prevalence of new HIV cases. After many years of research, the PrEP program was FDA-approved in 2012; therefore, it is the responsibility of advanced practice nurses to know current, evidenced-based prevention and treatment recommendations as they take their place as a vital member of the healthcare team.