TY - JOUR
T1 - Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States
T2 - A Narrative Review
AU - Mayer, Kenneth H.
AU - Agwu, Allison
AU - Malebranche, David
N1 - Publisher Copyright:
© 2020, The Author(s).
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Abstract: Antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV transmission was first approved by the US Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest where PrEP has been deployed, the uptake of PrEP is lagging, particularly among populations with disproportionate HIV burden. This narrative review seeks to identify individual and systemic barriers to PrEP usage in the USA. A comprehensive search of recent literature uncovered a complex array of structural, social, clinical, and behavioral barriers, including knowledge/awareness of PrEP, perception of HIV risk, stigma from healthcare providers or family/partners/friends, distrust of healthcare providers/systems, access to PrEP, costs of PrEP, and concerns around PrEP side effects/medication interactions. Importantly, these barriers may have different effects on specific populations at risk. The full potential of PrEP for HIV prevention will not be realized until these issues are addressed. Strategies to achieve this goal should include educational interventions, innovative approaches to delivery of HIV care, financial support, and destigmatization of PrEP and PrEP users. Until then, PrEP uptake will continue to be suboptimal, particularly among those who need it most.
AB - Abstract: Antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV transmission was first approved by the US Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest where PrEP has been deployed, the uptake of PrEP is lagging, particularly among populations with disproportionate HIV burden. This narrative review seeks to identify individual and systemic barriers to PrEP usage in the USA. A comprehensive search of recent literature uncovered a complex array of structural, social, clinical, and behavioral barriers, including knowledge/awareness of PrEP, perception of HIV risk, stigma from healthcare providers or family/partners/friends, distrust of healthcare providers/systems, access to PrEP, costs of PrEP, and concerns around PrEP side effects/medication interactions. Importantly, these barriers may have different effects on specific populations at risk. The full potential of PrEP for HIV prevention will not be realized until these issues are addressed. Strategies to achieve this goal should include educational interventions, innovative approaches to delivery of HIV care, financial support, and destigmatization of PrEP and PrEP users. Until then, PrEP uptake will continue to be suboptimal, particularly among those who need it most.
KW - Access
KW - Barriers
KW - Distrust
KW - Emtricitabine
KW - Implementation
KW - Pre-exposure prophylaxis
KW - Prevention
KW - Stigma
KW - Tenofovir alafenamide
KW - Tenofovir disoproxil fumarate
UR - http://www.scopus.com/inward/record.url?scp=85083091950&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85083091950&partnerID=8YFLogxK
U2 - 10.1007/s12325-020-01295-0
DO - 10.1007/s12325-020-01295-0
M3 - Review article
C2 - 32232664
AN - SCOPUS:85083091950
SN - 0741-238X
VL - 37
SP - 1778
EP - 1811
JO - Advances in Therapy
JF - Advances in Therapy
IS - 5
ER -