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Review
. 2018 Feb 1;77(2):119-127.
doi: 10.1097/QAI.0000000000001579.

Evolving Models and Ongoing Challenges for HIV Preexposure Prophylaxis Implementation in the United States

Kenneth H Mayer  1   2   3 , Philip A Chan  4 , Rupa R Patel  5 , Charlene A Flash  6 , Douglas S Krakower  1   2   3
Affiliations
Review

Evolving Models and Ongoing Challenges for HIV Preexposure Prophylaxis Implementation in the United States

Kenneth H Mayer et al. J Acquir Immune Defic Syndr. .

Abstract

Background: The use of preexposure prophylaxis (PrEP) for HIV prevention was approved by the Food and Drug Administration in 2012, but delivery to at-risk persons has lagged. This critical review analyzes the current state of PrEP implementation in the United States, by reviewing barriers and innovative solutions to enhance PrEP access and uptake.

Setting: Clinical care settings, public health programs, and community-based organizations (CBOs).

Methods: Critical review of recent peer-reviewed literature.

Results: More than 100 papers were reviewed. PrEP is currently provided in diverse settings. Care models include sexually transmitted disease clinics, community health centers, CBOs, pharmacies, and private primary care providers (PCPs). Sexually transmitted disease clinics have staff trained in sexual health counseling and are linked to public health programs (eg, partner notification services), whereas PCPs and community health centers may be less comfortable counseling and feel time-constrained in managing PrEP. However, PCPs may be ideal PrEP providers, given their long-term relationships with patients, integrating PrEP into routine care. Collaborations with CBOs can expand PrEP care through adherence support and insurance navigation. Pharmacies can deliver PrEP, given their experience with medication dispensing and counseling, and may be more accessible for some patients, but to address other health concerns, liaisons with PCPs may be needed.

Conclusions: PrEP implementation in the United States is moving forward with the development of diverse models of delivery. Optimal scale-up will require learning about the best features of each model and providing choices to consumers that enhance engagement and uptake.

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Conflict of interest statement

Conflicts of Interest: PAC has no conflicts of interest.

Figures

Figure 1
Figure 1
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References

    1. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–2599. - PMC - PubMed
    1. Choopanya K, Martin M, Suntharasamai P, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2013;381(9883):2083–2090. - PubMed
    1. Baeten JM, Donnell D, Ndase P, et al. Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women. New England Journal of Medicine. 2012;367(5):399–410. - PMC - PubMed
    1. Thigpen MC, Kebaabetswe PM, Paxton LA, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–434. - PubMed
    1. Grohskopf LA, Chillag KL, Gvetadze R, et al. Randomized trial of clinical safety of daily oral tenofovir disoproxil fumarate among HIV-uninfected men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2013;64(1):79–86. - PubMed

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