What Are Some of the Challenges of Improving PrEP Delivery & Adherence?

Kenneth Mayer, MD, Medical Research Director, Professor of Medicine, Fenway Health, Harvard University, discusses the current challenges of improving pre-exposure prophylaxis delivery and adherence in the United States.

Interview Transcript (slightly modified for readability)

“People who are at risk for HIV may have other behavioral health issues or social challenges that put them at risk. For example, they may be depressed, which is why they’re not protecting themselves against HIV; they may be using substances that may impair their judgment. These are things that can affect their pill-taking behavior, and [pre-exposure prophylaxis] PrEP, to be successful, means taking a pill every single day.

In terms of improving PrEP delivery, the biggest challenge right now in the United States, is training providers. There’s something a colleague of mine calls the ‘purview paradox.’ Infectious disease specialists are more used to taking care of people living with HIV, not high-risk individuals, so, they don’t necessarily feel comfortable doing all of the counseling that goes into deciding who’s an appropriate candidate for PrEP. Generalists oftentimes feel uncomfortable; they’re busy, they don’t have a lot of time to talk about sex with their patients. Another challenge that they may have is, they’re not comfortable with the medications themselves; they’re not used to prescribing antiretroviral medication. So, in terms of improving delivery, education of providers, and working through the barriers that they perceive to PrEP prescription, I think is a big step.

In terms of improving adherence for people, once they get a PrEP prescription, the biggest challenges are to work with them to address the social and behavioral issues that might make it hard for them to take PrEP. If somebody’s homeless, it may be harder to take a pill every day. So, it’s not considered part of medical care, but part of best practices, is working with social workers or other services to ensure somebody has a stable living condition, which will help ensure that they’re able to take the medication on a regular basis.”