Improve patient education on PrEP therapies
Frank J. Palella Jr, MD: The steps we take to positively reinforce a patient’s decision to enter therapy, to retain them in care, to ensure follow-up, include that village of health care providers that I talked about: not just physicians, nurse practitioners [nurse practitioners]and PA [physician assistants] but also nurses, pharmacists, receptionists, planners, social workers and social workers. It has everything to do with creating an environment in which patients feel they are doing something important in maintaining their health and preventing disease. That they are taken seriously by other people in a welcoming environment where they feel listened to and respected, and that they can feel comfortable disclosing the most intimate details of their lives and that they will receive a positive response. Should difficulties arise, including financial difficulties regarding access to medicines, they would be resolved in resourceful and innovative ways. It is about the provision of health care, just like the provision of health care for other conditions.
However, we have the additional social components of lifestyle, and unfortunately, we still have the potential stigma and discrimination that can arise for many people who are at greatest risk of contracting HIV and who need PrEP the most. . [pre-exposure prophylaxis]. Like our patients who are already on treatment for HIV, aspects of social status and management of the social determinants of health, including the ability to address or refer to resources for things like mental health, addiction, stigma, poverty, housing and safety and others are very important. You’ll get a very similar response from most providers who care for patients in this space.
We also need to be aware that some of the traditional risk groups we talk about as being eligible to receive PrEP are not always so inclusive. For example, it’s only recently that we’ve started talking about cisgender women — especially those who live in communities with the highest HIV prevalence and incidence, even in the United States — as a target. important and a priority for PrEP awareness, PrEP initiation and PrEP maintenance in care.
Access to injectable PrEP is improving in individual clinics, along with systems to streamline the process of scheduling patients, getting them in for their injection, and managing drug acquisition, including pharmacists and social workers to access healthcare or pharmaceutical benefits through third-party payers. It is important to be comfortable within the health care delivery system regarding the simplified approach to seeing people every 2 months, reminding them of their visits and undertaking an STD [sexually transmitted disease] screening at the time of these visits for other STDs unrelated to HIV, such as syphilis, gonorrhea and chlamydia. Access is becoming easier as more PrEP recipients and more clinics take up long-acting PrEP. Long-acting PrEP is here to stay. We will see more patients and providers opting for long-acting PrEP as the first line for their PrEP-eligible patients.
Lynne H. Milgram, MD, MBA, CPE: We have no barriers to treatment. We also have specialized clinics. We have areas that we believe are safe and protected with very competent service providers, including navigators. But as a healthcare system, where we do such a good job of coordinating so many disease states, we just don’t do it here. We have case managers for actual AIDS patients, but we don’t have case managers or care coordinators who deal with PrEP. We leave it to the providers, and they’re specialized, but I don’t think we have good systems, electronic or otherwise, that track these patients. Some are lost sight of. Unfortunately, this is not an area that we have started to focus on.
Transcript edited for clarity.