Barriers to PrEP Use

Segment Description: Julia Marcus, PhD, MPH, assistant professor at Harvard Medical School and Harvard Pilgrim Health Care Institute, discusses the barriers of PrEP use and how current prescribing guidelines are used in clinical practice.

Contagion^®: PrEP is very effective when used properly, yet many people who are at an increased risk for HIV are not on PrEP. Why do you think this is and how can we address this?

Dr. Marcus: There are many barriers to PrEP use and there's been a lot of work done on this in a lot of different settings.

So, some of those barriers are lack of awareness, cost, mistrust of the medical system. And, one of the barriers that we focused on in our study is that providers have a hard time identifying patients who are at high risk of HIV acquisition.

There are guidelines from the CDC about indications for PrEP use — for example, having a recent sexually transmitted infection or sharing needles. So, we do have some guidelines about how to prescribe PrEP, but, the reality is the assessment that the CDC provides in terms of assessing a patient for PrEP suitability is not really used in clinical practice. And, we still have a lot of providers who don't really know which of their patients should have PrEP or even have it on their radar at all.