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PrEP Care Should Be Viewed as a Continuum: Here's Why

MAR 02, 2017 | KRISTI ROSA
In a study conducted last year, the researchers took a closer look at clinical programs in cities in Rhode Island, Mississippi, and Missouri, and they found that more than half (60%) of the patients who signed up for PrEP ended up remaining in care after six months of treatment. In the current study, the researchers sought to identify areas of the process where interventions may be used to “improve access to PrEP” as well as the retention of the patients in care.
According to the press release, the researchers came up with nine steps:
  1. Identifying individuals at highest risk for contracting HIV
  2. Increasing HIV risk awareness among them
  3. Enhancing PrEP awareness
  4. Facilitating PrEP access
  5. Linking to PrEP care
  6. Prescribing PrEP
  7. Initiating PrEP
  8. Adhering to PrEP
  9. Retaining individuals in PrEP care
The first three steps are dedicated solely to PrEP awareness. “These three steps are important to start the continuum of care. Specifically, we have noted that perceived risk of HIV is a key barrier to uptake in a lot of people (eg people who are at risk of HIV underestimate their risk). HIV is often heavily stigmatized because of the way it’s transmitted, and many people believe that they couldn’t actually acquire HIV,” explained Dr. Nunn.

The central focus of steps four through seven concern PrEP uptake. When asked if this will address patients’ socioeconomic status, as well as gender and racial-specific considerations that can impact PrEP uptake, Dr. Chan said, “We believe a culturally congruent response to PrEP care is important for ALL steps for the continuum. Populations of color as well as men who have sex with men (MSM) are at disproportionately higher risk for contracting HIV. While PrEP uptake has been high among white MSM, it has been much lower for African American and Hispanic populations. We have also found that people of color are retained in PrEP care at lower rates than their white counterparts. All of these challenges highlight the importance of tailoring programs to these specific subpopulations.”
For populations who are at highest risk, adherence to PrEP regimens are all the more important and potentially lifesaving. When it comes to the implementation of these steps, to ensure that those who are, in fact, at highest risk will be identified and assisted, Dr. Nunn explained, “We need healthcare providers who can provide culturally appropriate PrEP care services. We also have found that patients often need ‘wrap around’ services to navigate health systems. These can be provided by clinical support staff.”

Retention in care may be an even more important measure of success for the evaluations of the public health impact of PrEP than adherence, according to the researchers. For this reason, Drs. Nunn and Chan will be completing additional studies to understand when and why patients cease to be retained in care.
“We need to understand WHY people aren’t being retained in care and to explore different approaches to keep them in care. This may include ways to stay more engaged with patients, such as having a patient navigator who helps respond to clients’ specific needs,” Dr. Chan concluded.
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