PrEP Implementation: Challenges and Opportunities

Dr Sinead Delany-Moretlwe presented a plenary regaring the implications of implementation of PrEP.

In November 2015 the World Health Organization recommended that PrEP be offered to high risk individuals. This was based on key evidence of 12 randomized controlled trials of oral PrEP effectiveness. PrEP was found to be effective at reducing HIV across age, gender or mode of HIV acquisition. The caveat to this was the effectiveness of PrEP depended on the level of adherence.

The greatest impact and cost effectiveness of PrEP will be in populations where HIV incidence is >3 per 1000 person years.

As a result of the WHO recommendations truvada as PrEP has been approved in more than 17 countries and just recently has been approved in Belgium, Portugal, Brazil and now the UK. US data of retail pharmacies has shown a dramatic increase in the rates of PrEP prescribing. There has been a 738% increase in prescribing since PrEP was recommended. UNAIDS has estimated that >160,000 people globally are currently on PrEP. However the targets set for those on PrEP by 2020 is 3 million people.

So what does PrEP offer for the patient? Decreased anxiety, increased disclosure amongst partners, increased intimacy and trust and increased self efficacy.

However there are significant barriers to PrEP use and these involve stigma surrounding its use. Other perceived barriers include:

1.) Safety in terms of side effects and effects on bone/renal health

2.) Resistance

3.) Longer term follow-up

4.) Development of safer drugs

5.) Potential effects in pregnancy and breast-feeding

6.) Cost especially if public funding is involved

The key questions to implementation include- how do you create demand? How do you supply demand? How do you support effective use?

Certainly many of the challenges can be seen as opportunities to strengthen and revitalize sexual health services for those most in need.