Since its discovery, HIV has spread to every region in the world and is one of the most important public health crises of our time. Pre-exposure prophylaxis (PrEP) has demonstrated efficacy in preventing HIV. While PrEP use is expanding globally, there is little consensus about how to measure progress in PrEP care other than to measure the number who initiate and adhere to PrEP and then assign reductions in HIV incidence. The PrEP care continnum has been described previously as including: (1) Identifying individuals at risk; (2) increasing their knowledge of PrEP; (3) ensuring access to PrEP; and (4) adherence to medication after PrEP initiation. However, after significant progress in PrEP implementation, there is a need to revisit and expand this framework.
[Photo: Dr. Amy Nunn]
The purpose of this paper, led by Dr. Amy Nunn, Associate Professor of Behavioral and Social Sciences and Executive Director of the Rhode Island Public Health Institute, was to draw on more than four years of PrEP implementation experience to propose a PrEP care continuum that assesses the multiple steps related to PrEP uptake, adherence, and retention in care. Because PrEP is intended to reduce HIV acquisition rather than treat disease, PrEP-related outcomes differ from the HIV care continuum. Nunn and her collaborators propose that the PrEP care continuum should include the following points: (1) Identifying individuals at highest risk for contracting HIV; (2) increasing HIV risk awareness among those individuals; (3) enhancing prep awareness; (4) facilitating PrEP access; (5) linking to PrEP care; (6) prescribing PrEP; (7) initiating PrEP; (8) adhering to PrEP; and (9) retaining individuals in PrEP care.
Broadly, the first three steps of the continuum reflect PrEP awareness, steps four through seven are related to PrEP uptake, while the final two steps focus on adherence and retention in PrEP care. The experiences of Nunn and her colleagues implementing PrEP suggest that each of these steps present opportunities for patients to continue using PrEP or disengage with care, and thus are important points of intervention.
This study was published in AIDS, 2017 (ahead of print).
For more information: https://www.ncbi.nlm.nih.gov/pubmed/28060019