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Pre-exposure prophylaxis, or PrEP, is a way for people who do not have HIV but are at substantial risk of contracting it to prevent HIV infections by taking a pill every day. It has been proven to be extremely effective at combating the spread of HIV infection. When taken consistently, HIV PrEP has been shown to reduce the risk of HIV infection in people who are at a high risk by up to 92%. Despite its effectiveness, however, PrEP has taken many years to catch on, especially in Public Health departments where its use can be the most effective. In North Carolina, for example, only a few public health departments prescribe PrEP and only a handful more screen and refer candidates to other PrEP clinics. In the more rural areas of the state, there are no prescribing clinics at all.

One of the major barriers to getting more people on PrEP is not having sexual health and risk evaluations done as part of routine testing and car, as providers have competing demands and may lack the training and comfort to discuss in-depth sexual health with their patient. There has also been a stigma surrounding the drug’s use that has made the most vulnerable and at-risk populations shy away from asking providers for information. Still, there is also a cost issue associated with taking daily PrEP. Without insurance, PrEP costs about $1300 per month, plus the added expenses of office visits and routine lab work.

A Public Health department is a great location for discussing and prescribing HIV PrEP to at-risk populations. We have previously discussed the ability of use Electronic Health Record data to pinpoint the best recipients of HIV PrEP. You can also combine sexual history discussions for PrEP with other programs you offer in your health department. Clinical guidelines for prescribing or referring for PrEP include anyone who has had a recent bacterial STI or who is an intravenous drug user. Patients may come in for other services such as STD screenings and treatment who may also be at risk for HIV infection.

To help defray the costs associated, most insurance providers cover at least part of the drug’s cost, since it generally cheaper to pay for prevention than to cover the costs of treatment post infection. Gilead Sciences, the makers of Truvada, the drug name for HIV PrEP, also offers patient payment assistance programs for those unable to afford the medication.

Public Health Departments are on the front lines of combating infectious diseases like HIV and often see the most vulnerable populations for infection. Together we can continue to fight as new research and medication are found and utilized.

HIV PrEP Resources

More information from the CDC – PrEP Fact Sheet

Clinical Practice Guidelines for PrEP

Preventing HIV Infection in the Primary Care Setting: The Role of Pre-Exposure Prophylaxis (PrEP) is a video-based medical education program designed to prepare healthcare providers to use biomedical HIV prevention strategies (PrEP) with their patients. This activity is intended for primary care physicians, ID/HIV specialists, nurses, and public health & preventive medicine specialists.