Pre-exposure prophylaxis (PrEP) is a once-a-day pill regimen and was first approved by the US Food and Drug Administration as a biomedical in HIV prevention in 2012 (Holmes, 2012; US Food and Drug Administration, 2012). Guidelines for initiating PrEP in primary care settings are widely available from multiple government agency websites (Centers for Disease Control and Prevention, 2014; World Health Organization, 2015).The introduction of PrEP treatment for HIV prevention concept has recently gained traction among clinicians (Smith, Mendoza, Stryker, & Rose, 2016). Between 2012-2015, it was reported that participation in the PrEP program reached approximately 79,000 consumers in the United States (Mera et al., 2016). Compared to the total estimated 120,000 new HIV infections between 2012-2015 (Centers for Disease Control and Prevention, 2015), it is important to emphasize that the PrEP program is still vastly underutilized.
Method:
A review of current clinician guidelines for initiating PrEP was gathered from the Centers for Disease Control and the World Health Organization (Centers for Disease Control and Prevention, 2014; World Health Organization, 2015). The recommendations from these organizations were synthesized based on the appropriate clinical practice for primary care providers (PCP). A review of literature also explored reported barriers to care in primary care facilities.
Findings:
The current official clinician guidelines for PrEP initiation are tailored specifically for PCPs. In general, a majority of the primary care clinics have standard operating business hours from 8-5pm, Monday to Friday. Less than 28 percent of adults sampled in a research driven survey indicated that they were able to seek medical care from their PCP during evening hours or weekends (Schoen et al., 2007). Some studies also reported that same day scheduling is not possible in primary care practice (Mehrotra, Keehl-Markowitz, & Ayanian, 2008). In addition, most primary care settings only cater to certain commercial insurance policy holders in their practice. Thus, patients covered by government assistance insurance programs and uninsured patients will have difficulty locating a PCP for PrEP services.
Discussion:
While the primary care setting should remain as the treatment facility of choice for PrEP services, the program could be expanded beyond present boundaries. Presently, there are approximately 7,400 Urgent care (UC) centers within the United States (Urgent Care Association of America, 2017). The UC is a unique entity as they are usually staffed by PCP’s, they have extended operating hours, and patients may walk in for care without having a scheduled appointment (Weinick, Bristol, & DesRoches, 2009). This provides ample opportunity for UC medical providers to offer PrEP services to patients seeking this option.
There are approximately 1.5 million Non-Governmental Organizations (NGOs) in the United States (U.S. Department of State, 2017). Local NGOs have been known encourage and facilitate HIV/AIDS outreach prevention programs within the local community centers, including linking uninsured patients with appropriate programs. Many pharmaceutical companies also provide treatment medication resources through the NGOs to support such activities. This provides another resource for the local hospital or community free clinic to collaborate with NGOs in providing PrEP services.
Conclusion:
PrEP is a lifesaving HIV prevention medication and it should not be solely introduced by a PCP in a primary care setting. If medical providers are aware of and understand current recommended PrEP treatment protocol, all providers can play a major role in providing PrEP services, and thus preventing additional HIV infections. The proposed solutions may engage patients in pursuing PrEP service utilizations, regardless of their current health insurance status.