Implementation of HIV Preexposure Prophylaxis in Diverse, Real-World Settings

Abstract

Global HIV incidence remains high, with approximately 1.5 million new infections reported in 2020. 1 Preexposure prophylaxis (PrEP) consisting of oral tenofovir disoproxil fumarate and emtricitabine has been shown to be highly effective in preventing HIV infections. Oral daily PrEP (D-PrEP) is effective in preventing HIV among men who have sex with men (MSM), cisgender women, people who inject drugs, and transgender persons, whereas oral event-driven PrEP (ED-PrEP), taken around the time of sexual intercourse, has been shown to be effective among MSM. However, global implementation of PrEP has been slow, especially in resource-limited settings, and there is a paucity of data from low-and middle-income countries examining real-world efficacy of PrEP that is essential to guide and support implementation.In JAMA Network Open, Wang et al 2 report results from the elegantly designed China Real-World Oral Intake of PrEP (CROPrEP) cohort, a novel study that examined real-world use of D-PrEP and ED-PrEP for MSM at risk of acquiring HIV in China. In the CROPrEP study, HIV-seronegative MSM chose to enroll in either D-PrEP or ED-PrEP cohorts with follow-up for HIV seroconversion for 12 months. Five hundred three participants opted to take ED-PrEP, and 520 opted to take D-PrEP. At the same time, 507 MSM who declined to initiate PrEP were enrolled into an observational cohort, which allowed for a contemporaneous assessment of HIV incidence among MSM not using PrEP. The

Get2PrEP2—A Provider Messaging Strategy to Improve PrEP Uptake: A Randomized Controlled Quality Improvement Project

“…Although provider education may seem like a solution to this issue, more than education may be needed as a recent enhanced provider training module did not significantly increase the number of participants prescribing HIV-PrEP [ 32 ]. A more thorough understanding of the types of training needed can help guide future efforts to improve PrEP uptake and delivery, such as tailored local educational resources and implementing system-level interventions such as trained navigators to support providers in PrEP discussions and initiation in diverse settings [ 33 , 34 ]. A recent systematic review of PrEP opportunities in US EDs showed the feasibility of counseling, scheduling, and referring patients for PrEP care [ 35 ].…”