The HIV-prevention medication PrEP has been hailed as a game changer in public health circles, one that could help slash rates of infection, save hundreds of thousands of dollars in individual healthcare costs and save lives.
But both providers and patients have been largely in the dark about PrEP, or pre-exposure prophylaxis. Now, Washington, D.C., which has one of the highest rates of HIV infection in the country, is launching a campaign to bring light to this option. Experts warn, however, that questions of access loom large.
When the once-a-day PrEP pill is taken consistently, it's been shown to cut the risk of HIV transmission by 90% or more.
Yet, participants in focus groups gathered for the campaign had no idea PrEP existed.
“Here was a practical and vital preventive health opportunity for them that nobody had been telling them about,” said Michael Kharfen, the senior deputy director for the D.C. Health Department's HIV/AIDS, Hepatitis, STD & TB Administration.
Public health officials in D.C., where the infection rate exceeds the World Health Organization's definition of a generalized epidemic, hope to change that through advertisements publicizing the drug and its effect.
The ads target African-American women who make up about 90% of the female population in D.C. infected with HIV. Out of all new HIV infections, African-American women constitute 20%, the district's public health department reports. That proportion is second only to African-American men who have sex with men.
Kharfen said a health and wellness center set up this fall will allow women to get PrEP directly. The district is working with community health centers and educating local providers about the drug because despite the medication's potential, significant obstacles in the healthcare system stand between a patient and PrEP.
PrEP has to be prescribed by a physician, but many doctors are not aware of it.
A survey of 1,500 physicians and nurse practitioners recently published in the journal PLOS One found that awareness of PrEP among these providers increased significantly, from 24% in 2009 to 66% by 2015. Still, from 2009 until 2012 less than 1% of them had prescribed PrEP, a proportion that by 2015 had risen to 7%.
With a month's worth of the drug priced at more than $1,000, according to the Department of Health, cost is another potential issue. Both Medicare and Medicaid cover PrEP, Kharfen said, as do most private insurers, but co-pays for the drug vary by plan. If a person is uninsured, Gilead, which makes Truvada, the only FDA-approved PrEP medication, offers a discount to help cover the full cost of the medication.
The lifetime cost of caring for someone with HIV totals about $400,000, Kharfen said. He estimated that about half of those with HIV in the district were on Medicare or Medicaid (in Washington, about 68% of the African-American population is on Medicare and about 78% on Medicaid), so in addition to helping a person avoid lifelong disease, in the most callous terms, every prevented HIV infection saves taxpayer dollars.
The desire to take PrEP could also serve as an entry point to the healthcare system. “It is primarily about taking the med every day, but it's also about how this fits into your regular health,” Kharfen said. “We just want to convey that this is empowering for women, an opportunity for them to take charge and dominate their sexual health.”
An earlier version of this story incorrectly reported comments from Dr. Shawnika Hull of George Washington University, which now have been omitted. Modern Healthcare apologies for the error.