PEP underutilized for HIV prevention, study suggests
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Key takeaways:
- Roughly one-third of people eligible for HIV post-exposure prophylaxis did not receive a prescription.
- Fewer eligible people were prescribed HIV PEP in acute care settings vs. non-acute care settings.
Post-exposure prophylaxis for HIV remained significantly underutilized, especially in acute care settings, according to study results published in Open Forum Infectious Diseases.
“Our findings confirm that post-exposure prophylaxis [PEP] was not prescribed in nearly one-third of instances where it was indicated, with acute care settings having a higher rate of missed opportunities,” Lao-Tzu Allan-Blitz, MD, associate epidemiologist in the division of global health equity at Brigham and Women’s Hospital in Boston, told Healio.
Antiretroviral-based PEP is recommended by the CDC and WHO “as a key component of the strategy to combat the HIV epidemic,” Allan Blitz and colleagues wrote. PEP using the antibiotic doxycycline has recently been shown to prevent bacterial STIs.
Allan-Blitz said it became clear to him that PEP was being underutilized for HIV during meetings to develop WHO guidelines for PEP in late 2023, but the explanation for why was “relatively vague and hypothetical.”
“We wanted to investigate if, in the last 10 years since the prior WHO PEP guidelines were released, what data existed on missed opportunities for PEP prescribing and if we could understand what barriers might exist,” he added.
Allan-Blitz and Kenneth H. Mayer, MD, professor of medicine at Harvard Medical School and medical research director and co-chair of The Fenway Institute in Boston, analyzed 20 studies published during the last 10 years that included 43,832 participants.
The researchers estimated that 41,477 individuals were eligible for HIV PEP, however, only 66.8% received a prescription.
Additionally, results showed a higher likelihood for non-acute health care settings to prescribe HIV PEP compared with acute health care settings (94.5% vs. 63.5%; P < .001). According to the researchers, the major barriers to improved PEP prescribing included low provider and patient awareness, HIV stigma, homophobia, transphobia, binophobia and systemic factors, such as lack of access to care or unavailability of medication.
“Programs aiming to implement PEP may benefit from considering acute care settings in particular, as well as interventions to increase access and awareness, and reduce stigma,” Allan-Blitz said.
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