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

MAR 02, 2017 | KRISTI ROSA
Over 36 million individuals worldwide are living with HIV/AIDS and the disease has accounted for over 35 million deaths. The good news is, with new treatment options, such as antiretroviral therapy (ART), an HIV diagnosis no longer equates to a death sentence. Those who are at particularly high risk of infection can now take pre-exposure prophylaxis (PrEP) as a means of prevention. However, adherence is key with PrEP, and oftentimes, sticking firmly to a treatment regimen can be particularly challenging.

Keeping this in mind, researchers at Brown University are looking for ways of improving preventive care. To do so, they have proposed a new system “for understanding and evaluating how PrEP is implemented in clinical practice,” according to a recent press release. In this system, they view PrEP care as a continuum of care consisting of nine steps, which they hope will help practitioners better assess where patients might cease the preventive care that could protect them from infection.

In an email exchange with Contagion®, Amy Nunn, ScD, MS, associate professor at the Brown University School of Public Health, explained the importance of a continuum. She said, “It is helpful to view PrEP care as a continuum of ‘steps’ to understand exactly how we can provide them care that responds to their HIV prevention needs. Some patients need help understanding their HIV risks, some need help navigating the medical system, some may have trouble adhering, and some may not be able to afford medical services. We felt it was important to identify these steps.” She continued, “We thought it was important to highlight challenges related to uptake and care, both of which have been somewhat overlooked in public policy discussions related to PrEP. We want to emphasize retention in care because many people are lost to follow-up, and retaining people is important for reducing their HIV risks.”

When it comes to PrEP programs, healthcare practitioners have noted that a number of individuals face difficulties when it comes to adhering to their prescribed treatment regimens; this happens for a number of different reasons depending on each patient. The following factors can make adherence a challenge: a busy schedule can make it harder to take medications on time, troublesome side effects “from interactions between HIV medicines and other medicines an individual may take,” alcohol/drug use that may interfere with daily life, and some individuals simply do not have health insurance and cannot afford HIV medications. According to the Brown researchers, at first, in studies, PrEP adherence seemed “promising,” but they found out that real-world clinical settings are much different than research studies.

In an email interview, Philip Chan, MD, co-author of the paper, assistant professor of medicine at Brown’s Warren Alpert Medical School and an infectious disease physician at the Miriam Hospital, explained to Contagion®, “In research studies, people are often paid financial incentives to attend visits. In a couple of the large research trials, individuals reported taking the PrEP medication when they weren’t. We don’t fully understand why, but they may have continued coming to clinical visits because of the financial incentives for participating in the trial. In real-world clinical settings, there are no incentives for visits; patients usually present for clinical care because they are interested in improving their health and well-being.”

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