HIV Pre-Exposure Prophylaxis (PrEP) and Sexual Transmitted Infection (STI) Testing: Recommendations for Expanded Access and Public Health Implications in North Carolina
Creators: name: Porter, Thomas
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2019

description: HIV has had a devastating impact on communities around the world since its emergence as an epidemic in the early 1980s. Today, over 1.1 million Americans are living with HIV, with new infection rates remaining relatively stable overall, yet increasing in certain vulnerable populations. Over 35,000 North Carolinians live with HIV, with adults between the ages of 20 to 29, gay and bisexual men, and African Americans being disproportionately affected. Historically, HIV prevention has centered around behavioral risk reduction, including the promotion and utilization of condoms as risk reduction strategies. Emtricitabine-tenofovir (brand name Truvada®) was the first antiretroviral medication approved by the United States Food and Drug Administration (FDA) for pre-exposure prophylaxis (PrEP) as a new evidence-based prevention strategy. In clinical trials, emtricitabine-tenofovir/PrEP was shown to reduce the risk of acquiring HIV by approximately 90 percent in participants who took the medication as indicated. Emtricitabine-tenofovir/PrEP is prescribed to HIV-negative patients who are at a high risk for becoming infected with HIV. These include gay and bisexual males, individuals with multiple sexual partners, transgender women, injection drug users, and people with an HIV-positive partner, among others. Multiple clinical studies have concluded that there is no significant change in sexual behaviors, nor are there significant increases in rates of sexually transmitted infection in patient populations regularly taking emtricitabine-tenofovir/PrEP. Cost is a huge barrier to emtricitabine-tenofovir/PrEP access. Gilead, the maker of Truvada® (emtricitabine-tenofovir/PrEP), offers an Advancing Access Program, aimed at assisting with co-pay costs. The company also offers a Medication Assistance Program which provides emtricitabine-tenofovir/PrEP free of charge to those without health insurance. Primary care provider awareness is also a barrier to access, with many primary care providers reporting being unaware of emtricitabine-tenofovir/PrEP or not feeling comfortable prescribing it. Mecklenburg and Durham counties, two of the top seven North Carolina counties that have the highest average rates of new HIV infections, offer referrals for emtricitabine-tenofovir/PrEP. Patients can obtain prescriptions through their primary care doctor. Telemedicine options, like PlushCare, also exist as a convenient and discreet alternative. North Carolina relies on local health departments for HIV prevention and control services. Other states, like California, have adopted more aggressive health management programs aimed at expanding access to emtricitabine-tenofovir/PrEP. To reduce rates of HIV infection, as well as decrease the rates of other sexually transmitted infections, I will highlight the implications of North Carolina focusing funding efforts on emtricitabine-tenofovir/PrEP education and outreach programs, designed to increase rates of use across the state, particularly in populations at higher risk for HIV acquisition.