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Thursday May 10, 2018

For Your Patients' Sake, Prepare Yourself for PrEP

Robert is a young gay man who was having unprotected sex with other men. His risky behavior led him to be tested for HIV multiple times, and his tests always came back negative.

Until now.

Robert was referred to me after a recent test came back positive because I have experience and an additional certification in HIV care. One of the first questions he asked me was, "Why didn't anyone tell me about PrEP?"

It's a great question because too many patients are finding out about PrEP -- pre-exposure prophylaxis -- only after it's too late.

It's been six years since the FDA approved emtricitabine/tenofovir disoproxil fumarate (Truvada) for HIV prevention, yet too many high-risk patients like Robert still aren't being informed and prescribed a drug that could have prevented this type of diagnosis. According to the CDC,(www.cdc.gov) PrEP lowers the odds of getting HIV from sex by more than 90 percent and reduces the risk posed by injectable drug use by 70 percent.

In 2015, the agency reported that 25 percent of sexually active gay and bisexual adult men and 18.5 percent of adults who inject drugs were at substantial risk for HIV infection and should be counseled about PrEP to prevent infection. However, a survey of health care professionals that same year showed that more than two-thirds were not aware of the treatment.

Another survey,(www.ncbi.nlm.nih.gov) conducted in 2014-15 and published last year, showed better results regarding an awareness of PrEP but not a willingness to prescribe it. That survey showed that primary care clinicians were less likely than HIV specialists to have heard of PrEP (76 percent and 98 percent, respectively) and were far less likely to have prescribed it (17 percent, 64 percent).

Those numbers likely would improve if we asked the questions again today, three years later, but by how much? How many other patients like Robert are still not being informed about a medication that could make a difference?

It's worth noting that some women -- such as those who have an HIV-positive partner or those who use injection drugs -- also may benefit from PrEP.

Primary care physicians need to learn about this treatment, get comfortable with it and be able to prescribe it, or -- at a minimum -- know who to refer patients to in your community before it's too late. The CDC has resources for physicians and patients.(www.cdc.gov)  

Physicians who aren't familiar or aren't comfortable with prescribing PrEP should be aware that Ravi Grivois-Shah, M.D., M.P.H., M.B.A., associate professor of family and community medicine at the University of Arizona College of Medicine at Tucson, will be presenting a session titled "HIV Pre-exposure Prophylaxis and Post-exposure Prophylaxis in Primary Care: Stepping Into PrEP and PEP" during the Family Medicine Experience, which will be held Oct. 9-13 in New Orleans. The session also will also be available to physicians who can't make it to New Orleans as part of FMX On Demand.  

Ada Stewart, M.D., is a member of the AAFP Board of Directors.

Posted at 03:10PM May 10, 2018 by Ada Stewart, M.D.

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