Guest editorial: health policy analysis on improving HIV PrEP implementation to help end the HIV epidemic in the U.S. military

Abstract

Use of HIV pre-exposure prophylaxis (PrEP) among U.S. military service members at high risk for HIV infection remains suboptimal, resulting in preventable new HIV infections and decreased medical readiness among service members. PrEP coverage should be increased to the greatest extent possible to prevent HIV infection and support the Military Health System (MHS) quadruple aim. This policy analysis employed the Centers for Disease Control and Prevention (CDC)'s Policy Analytical Framework to develop several policy options based upon the evidence summary and interventions described. Evaluation criteria based on the CDC's Policy Analytical Framework incorporated all elements of the Military Health System (MHS)'s quadruple aim, including impact on population health and readiness, impact on the experience of care, and value in terms of cost-effectiveness. An additional criterion of feasibility was also added to account for cultural, societal, and political factors influencing this policy decision. This policy analysis suggests that HIV PrEP coverage in the MHS remains suboptimal, while several available interventions could result in substantial increases in PrEP coverage that would, in turn, result in further reductions in new service member HIV infections and increased medical readiness.

Keywords: HIV; MHS; Military Health System; PrEP; United States; armed forces; human immunodeficiency virus; policy; pre-exposure prophylaxis.