Many healthcare providers are reluctant to prescribe a prevention plan to their patients who are at substantial ongoing risk for HIV, according to a survey from the Group Health Research Institute.
The HIV prevention plan, called Pre-exposure prophylaxis, or PrEP, involves prescribing a regimen of HIV antiviral medication to individuals who don't have HIV to prevent the virus from establishing itself and multiplying in the body.
According to the survey of more than 300 members and specialty practitioners of the American Academy of HIV Medicine, fewer than half reported being "very likely" to prescribe PrEP to their patients who are high-risk heterosexuals or people who use intravenous drugs.
The results are concerning because these groups are prime candidates for PrEP, according to first author Leah M. Adams, PhD, a research fellow at Group Health Research Institute and counselor for people living with HIV.
According to the survey, reasons providers are reluctant to prescribe prevention plans include concerns about:
- Patients consistently taking a daily pill
- Regular follow-up care for monitoring and counseling
- Effectiveness of PrEP in preventing HIV
- Side effects
- Patients engaging in riskier behaviors because they assume PrEP will completely protect them; and
- Cost of treatment
According to coauthor Kathy Brown, MD, Group Health's HIV program lead, there is a strong evidence base for PrEP use that contradicts concerns about an increase in risky behavior, side effects, drug resistance and adherence.
"Recent 'real-world' studies (not clinical trials) of PrEP use do not support these concerns," said Dr. Brown.
The only concerns that do hold water are concerns associated with cost. The only FDA-approved PrEP costs around $40 per day, although some states have drug-assistance programs that cover patient drug expenses, according to the study
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