Photo Credit: Kiattisakch

Reducing insurance barriers, improving outreach, and streamlining the clinician workflow are part of a multifaceted strategy to increase injectable PrEP uptake.

“Even though new cases of HIV have declined in recent years, we are still seeing as many as 1.2 million new patients diagnosed annually, and HIV continues to affect certain segments of the population disproportionately—and severely,” Shimrit Keddem, PhD, MPH, notes. “PrEP is an evidence-based tool for reducing the number of new HIV cases.”

Oral PrEP, in the form of a daily pill, has been available since 2012, she continues, and long-acting injectable PrEP, administered as an injection every two months, was approved in 2021.

“Despite the availability of PrEP since 2012, however, uptake has been slow and was reduced significantly by the COVID-19 pandemic,” Dr. Keddem explains. “To reach our goal of ending the HIV epidemic, we need to boost PrEP prescriptions to anyone who would benefit from them and give patients as many options as possible that fit their preferences and lifestyles.”

For a study published in JAIDS, Dr. Keddem and colleagues examined factors that influence the implementation of long-acting injectable PrEP. The researchers interviewed clinicians and patients at a single healthcare center. Physician’s Weekly (PW) spoke with Dr. Keddem to learn more about the study results.

PW: How was the study conducted?

Dr. Keddem: Our goal was to evaluate the implementation of long-acting injectable PrEP in real-time as it was being rolled out. We interviewed key clinical personnel, leadership, and patients who use PrEP, injectable and oral formulations. We asked clinical staff about the processes and procedures for implementing long-acting PrEP, factors that helped or hindered implementation, and their knowledge and beliefs about PrEP. We asked patients about their communication with clinicians and their experience getting PrEP and follow-up care related to PrEP.

What findings are important to emphasize?

Both patients and clinicians expressed frustration over provider bias in offering PrEP only to certain groups of patients, such as White, cisgender gay men, instead of anyone who would benefit from PrEP, including women. Importantly, both patients and clinicians stressed the importance of having open and flexible conversations about sexual practices, discussing all the PrEP options, and tailoring advice to the needs and preferences of the patient. When possible, leveraging the resources of the interdisciplinary team—including patient navigators, pharmacists, and nurse managers—to support tracking, outreach, and follow-up with patients is key to successful PrEP care.

What concerns do patients have about long-acting injectable PrEP?

Among patients, fear of needles, issues with adherence to bimonthly appointments, and trust in pills over injectables were major barriers to long-acting injectable PrEP. Those who were afraid of needles automatically chose oral PrEP. In general, patients described an apprehension about new medical technologies and concerns about the efficacy of the injectable. Some patients considered an injectable to be “more serious” than a pill, worrying that it would not be reversible, especially if they experienced side effects. For some patients, adhering to a clinical visit every 2 months felt too burdensome when the oral medication could be delivered directly to their home, requiring less engagement with the healthcare system.

How can uptake be improved?

The most promising strategy for improving rollout and uptake is to make long-acting injectable PrEP hassle-free for the patients who want it. That means reducing insurance barriers, supporting patients with education and outreach, and making the experience a “one-stop shop.” Where possible, involving pharmacists in delivering long-acting injectable PrEP can streamline the workflow, reduce the clinical burden, and make PrEP more accessible to patients.

What are the implications of your findings?

Patients want to know all their options to be able to choose the one that is right for them in the context of their lives. To help combat the HIV epidemic, clinicians should have open conversations with patients about sexual health and offer PrEP broadly, presenting all the options in an inclusive and safe environment.

What should future research focus on?

Future research could focus on how best to communicate the different PrEP modalities, including their advantages and disadvantages, to patients to increase PrEP uptake. Studies could explore different types of health communication and promotional materials to relay information about different PrEP options. In addition, future studies should test interventions that leverage the role of pharmacists, especially community pharmacists, and programs that would make PrEP readily accessible directly to patients in “one-stop shop” options.