HHS Ready, Set, PrEp logo
A few days ago the US Department of Health and Human Services launched Ready, Set, PrEP. The program provides medication for pre-exposure prophylaxis (PrEP) to prevent HIV for people who are uninsured. This is great news. However, the success of this program and any other program to reduce the impact of HIV is dependent upon engagement of two critical partners not explicitly described in the announcement- health care providers and the community. My experiences training primary care providers to diagnose and treat HIV and educating the community about the infection highlight why it is vital to prioritize development of specific and focused strategies for their inclusion at every phase of this program.
Front line providers are critical for diagnosing HIV and identifying people eligible for Ready, Set, PrEP, yet, despite national recommendations for routine HIV screening, many of them are unprepared to do so. Furthermore, some are unwilling to prescribe PrEP due to fear and bias. During a grand rounds presentation for primary care providers, I used electronic polling software to assess provider awareness about and willingness to prescribe PrEP. In an audience of over 40 primary care providers only two were willing to prescribe PrEP. Reasons for this reluctance included being unfamiliar with PrEP, perceived difficulty discussing HIV with an established patient population and judgment and bias—meaning concerns that prescribing PrEP would encourage high-risk sexual behavior. Many of these providers also believed, even absent a discussion, they could decide which of their patients were at risk for HIV. How can access to PrEP be optimized if front line providers are unwilling or unable to help identify those who need it?
Furthermore, HHS recently reported a continued need to identify and treat HIV infection. The report encourages the public to “Talk with [a] healthcare provider about HIV prevention, including PrEP.” This is much easier said than done if front line providers are woefully unprepared to identify or meet the needs of those eligible for Ready, Set, PrEP.
And the community must be aware PrEP is available. Last summer while leading a community health discussion, the questions about HIV prevention and treatment demonstrated the continued need for better strategies to explain the science, biology and care continuum of HIV. The community remains unclear about HIV transmission, prevention, treatment and access. Only a few had heard of PrEP. The most knowledgeable person had experience as an HIV community health worker but even he was unclear about the difference between PrEP and HIV treatment. The latter suggests a dire need to improve our educational approach and prepare the non-clinical health care workforce to understand and speak about HIV before they are deployed into the community.
Earlier this year, HHS announced an unprecedented initiative to End the HIV Epidemic, (EHE). This initiative aims to reduce new HIV infections in the United States by 75 percent in five years and by 90 percent by 2030. Ready, Set, PrEP is but one component of the initiative. EHE is being touted as a once-in-a-generation opportunity. But if this truly is a once-in-a-generation opportunity, I hope it’s not squandered by failing to address provider bias and the communication and educational needs of front line providers and the community.
