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PrEP: Help End The HIV Epidemic

September 1, 2016

Image of a man holding a pill surrounded by the followint text: PrEP stands for Pre-Exposure Prophylaxis. Prophylaxis means to prevent or control the spread of an infection or disease. PrEP can help prevent you from getting HIV if you are exposed to the virus. PrEP is an HIV prevention option that works by taking one pill every day. One pill daily.
One of the most talked-about topics at this week's National Ryan White Conference in Washington, D.C., is a little blue pill that one out of four doctors has never heard of.

​​​​​Pre-exposure Prophylaxis, the pill commonly called PrEP, is as much as 92 percent effective in preventing HIV infection if taken daily, but little-known among those with the most reason to care -- clinicians and the people they treat who need it the most.

The Centers for Disease Control and Prevention believe only about 18,000 prescriptions for the drugs were written last year for the estimated 1.2 million people at high risk for HIV infection, according to the HIV/AIDS Bureau's (HAB) Dr. Polly Ross, a member of the HRSA PrEP Workgroup headed by RADM Deborah Parham Hopson. The group is training agency staff to get out the word to grantees and other stakeholders to screen patients routinely and prescribe the drug to affected patients who test negative.

"Take a look at the real world," said Dr. Anthony Fauci, Director of the ​National Institute of Allergy and Infectious Diseases​, at the National​ Ryan White HIV/AIDS Conference this week in Washington, D.C.

"If you look at a (recent) observational study in San Francisco, they found no new HIV infections in more than 1,200 men who were taking PrEP over nearly one and a half years -- with 82 new infections at the same clinic among men not enrolled in the PrEP program. Very important: What's good in San Francisco is also good in Uganda, because we see the same thing there – greater than 90 percent PrEP efficacy when there's adherence to the drug ... nothing is 100 percent, but this is about as close to 100 percent as you can get."​

Dr. Anthony Fauci, Director of the ​National Institute of Allergy and Infectious Diseases
PrEP Works: Dr. Fauci told conference-goers that early imperfect studies of the prevention drug reached equivocal findings that may have dampened prescriptions and use. "If you look at all the subsequent studies, its (effectiveness) is well over 85 to 90 percent. So this 'dispute' over whether PrEP works or not is no longer a dispute. It works."​  

​Yet, the sparse usage persists years after FDA approval of the medication – whose proven efficacy Ross and others describe as one of several recent dramatic advances in HIV prevention and care.

Underscoring the under-usage of PrEP, an estimated 1 out of 4 providers were unaware of PrEP in 2015, according to Dr. Ron Wolitski, Acting National Director of the HHS Office of HIV/AIDS and Infectious Disease Policy.

​"We definitely need to up our game," Ross said during a July 7 ​​HHS staff training webinar aimed at introducing the drug and HRSA's role in support of PrEP at the grassroots -- through Ryan White clinics, health centers and elsewhere. And it's timely, since the number of people being diagnosed with HIV annually (about 44,000) has remained largely unchanged for years.

HAB's Dr. Polly Ross
"Upping our game": Dr. Ross has been conducting training sessions on PrEP to heighten staff awareness -- part of an HHS-wide campaign to promote the drug in furtherance of the 2010 Comprehensive National HIV/AIDS Strategy goal of an "AIDS-Free Generation."   

At current testing and treatment rates, the CDC forecasts 265,000 new HIV infections will occur by 2020, Ross said. That projected number drops to slightly more than 80,000, a 78 percent decline, when PrEP is combined with expanded HIV testing and treatment.

People at the greatest risk of HIV infection include men who have sex with men, partners of those with HIV, and injection drug users.

Daily doses of PrEP reduced infection rates among those groups by 92 percent, 90 percent and 73 percent, respectively, according to a November report from CDC.

"In order to reduce the number of new HIV infections in the U.S., we must do something different - this is why we need better prevention tools, such as PrEP," said Ross.

HAB's Heather Hauck, Rene Sterling, Tanchica Terry and Antigone Dempsey
PrEP course: (From left) HAB's Heather Hauck, Rene Sterling, Tanchica Terry and Antigone Dempsey delivered a panel presentation on the promise of the new drug on Thursday, Aug. 25,​ at the National Ryan White Conference.

For more information, CDC has resources for patients and providers, as well as guidelines on PrEP​ (PDF - 867 KB) released by the US Public Health Service on May 14, 2014.

Date Last Reviewed:  July 2017