As healthcare management of HIV continues to evolve with new pharmaceutical options for prophylaxis and treatment, providers in all care settings need to be up-to-date on evidence-based utilization of these options(Karris, Beekman, Mehta, Anderson, & Polgreen, 2014). Around the globe, PrEP utilization is variable and there is a critical need for interventions that can effectively meet the needs of individuals who are without housing or stable shelter. Research has identified common barriers to implementation and adherence of PrEP therapy including concerns about safety, side effects, cost, and overall effectiveness of the regimen (Koechlin et al., 2017). Healthcare providers are in key positions to provide education and offer PrEP to individuals at increased risk for HIV infection (Haberer et al., 2017).
For individuals who are experiencing homelessness, access to care and financial barriers remain significant obstacles to obtaining needed care(Barker & Maguire, 2017). Unfortunately, among individuals who are without stable housing, infectious diseases remain a very real and ongoing threat and HIV continues to be a significant problem affecting overall health and quality of life. While targeted therapy has improved worldwide, more focus is needed on reaching this population of individuals.
Method:
A search was conducted for clinical trials, qualitative studies, or PrEP guidelines discussing the utilization of PrEP in individuals experiencing homelessness. To date, there is very little available evidence relating to the use of PrEP with this population. The review of literature identified several articles discussing adherence interventions, provider education and willingness to prescribe PrEP, clinical effectiveness of the regimen, and patient attitudes and behaviors relating to the use of PrEP (Bourne, et al., (2017); Alistar, Grant, & Bendavid, (2014); Chen & Dowdy, (2014). This information is helpful in evaluating the use of and response to therapy among different population groups and may serve as a guide for the development of interventions aimed at individuals who are experiencing homelessness.
Findings:
Healthcare providers who work with individuals experiencing homelessness are usually cognizant of the many barriers to healthcare seen in this population (Barker & Maguire, 2017). However, knowing the specific risks for contracting HIV and how to prevent infection within their living situation is critical information for individuals experiencing homelessness. New PrEP regimens are designed to effectively prevent infection in many individuals who are at increased risk for contracting the disease (Morton et al., 2017). Thus, there is great need to provide education about and access to PrEP to providers and individuals who are without stable shelter.
Discussion:
Homelessness is not restricted to one demographic or geographic area(Barker & Maguire, 2017). The provision of effective healthcare to this population is a critical need worldwide. One way of addressing this need is to provide ongoing education about HIV prevention and treatment to professionals who are caring for individuals experiencing homelessness. Facilitating access to treatment is another area of focus for providers along with consideration of financial constraints and barriers that are present(Cohen et al., 2016). In order to expand services to individuals without secure shelter, providers globally need to invest in education and outreach in order to improve HIV preexposure prophylaxis for this demographic. By partnering with non-profit organizations focused on HIV prevention and AIDS treatment, providers will be able to assist individuals in obtaining needed care.
Conclusion:
While current guidelines exist and are being developed to assist providers in the effective utilization of PrEP in the prevention of HIV in the setting of primary care, there is great need for expanding knowledge to include individuals who are experiencing homelessness and are at risk for acquiring HIV. PrEP has proven efficacy in preventing HIV and can substantially change the landscape of AIDS incidence and prevalence around the world. Healthcare providers who work with homeless persons should invest the time and energy needed to ensure that this potentially life-saving intervention is available for this vulnerable population.