CDC Vital Signs Show Need For Increased Awareness of PrEP

A new Vital Signs report shows that nearly 20 percent of adults who inject drugs, and less than 1 percent of�heterosexually active adults are at substantial risk for HIV infection and should be counseled about PrEP, a daily pill for HIV prevention.

"The CDC recommended PReP as one of several effective actions for reducing the risk of HIV infection. It's a daily pill for people at substantial risk for contracting HIV," said CDC Principal Deputy Director Anne Schuchat, M.D., in a telefconference. "When taken daily, PrEP can reduce your risk by 90 percent for sex and 70 percent for IDUs. A growing body of research shows that PrEP is incredibly effective when taken consistently."
�
PrEP for HIV prevention was approved by the Food and Drug Administration in 2012. When taken daily, it can reduce the risk of sexually acquired HIV by more than 90 percent. Daily PrEP can also reduce the risk of HIV infection among people who inject drugs by more than 70 percent. However, according to recent studies, some primary health care providers have never heard of PrEP. Increasing awareness of PrEP and counseling for those at substantial risk for HIV infection is critical to realizing the full prevention potential of PrEP.
�
"PrEP isn't reaching many people who could benefit from it, and many providers remain unaware of its promise," said CDC Director Tom Frieden, M.D., M.P.H. "With about 40,000 HIV infections newly diagnosed each year in the U.S., we need to use all available prevention strategies."

"The bottom line is, doctors need more prep about PrEP," said Schuchat. "We recognize that clinicians are working in a highly complex prevention landscape, but all tools should be used."
��
These include treatment to suppress the virus among people living with HIV; correct and consistent use of condoms; reducing risk behaviors; and ensuring people who inject drugs have access to sterile injection equipment from a reliable source.

A survey of doctors from 2015 estimates that 34 percent are not aware of PrEP. And although 2/3 of doctors are aware of it, that doesn't necessarily mean they are comfortable prescribing it. As it's a fairly new intervention, Vital Signs is issuing tools to make it easier to learn how to prescribe and talk about PrEP.

Jonathan Mermin, M.D., M.P.H, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said that PrEP was a powerful tool, but only if patients received it. Right now, we only have 30 percent viral suppression. It's important that clinicians begin discussing behavioral risks and identify those who could benefit from more information about PrEP.
�
"PrEP has the potential to dramatically reduce new HIV infections in the nation," said Mermin. "However, PrEP only works if patients know about it, have access to it, and take it as prescribed."
�
A separate analysis published in Vital Signs suggests that focused efforts can significantly expand the reach of PrEP. Researchers from the New York State Department of Health report that PrEP use among New Yorkers covered by Medicaid increased from 303 prescriptions filled from July 1, 2013-June 30, 2014, to 1,330 prescriptions filled from July 1, 2014-June 30, 2015 in the year, following the launch of a statewide effort to increase PrEP knowledge among potential prescribers and candidates.

The CDC has published resources to educate and advise providers -- including 2014 clinical guidelines, step-by-step PrEP checklists and interview guides -- and supports a hotline to answer providers' questions about when and how to offer PrEP.

PrEP is one of four focus areas in the July 2015 Update to the National HIV/AIDS Prevention Strategy. Other key elements of the Strategy and CDC's high-impact prevention approach are:
�