Preexposure Prophylaxis (PrEP) for HIV Prevention: The Primary Care Perspective

Area of Science:

• Public Health
• Infectious Disease Prevention
• Primary Care Medicine

Background:

• Limited office-based strategies existed previously to curb HIV transmission.
• The Centers for Disease Control and Prevention released guidelines in 2014 recommending pre-exposure prophylaxis (PrEP) for HIV prevention.
• Awareness of PrEP among primary care providers is currently low, limiting patient access.

Purpose of the Study:

• To highlight the importance of PrEP as an HIV prevention strategy in primary care settings.
• To outline the recommended patient populations eligible for PrEP.
• To detail the necessary clinical procedures and monitoring for PrEP initiation and management.

Main Methods:

• Review of updated CDC practice guidelines for HIV prevention.
• Identification of patient groups recommended for PrEP.
• Description of clinical protocols for prescribing and monitoring PrEP.

Main Results:

• PrEP, specifically daily oral tenofovir/emtricitabine, is a highly recommended (strength of recommendation, A) intervention for eligible high-risk individuals.
• Key populations include injection drug users, men who have sex with men, certain heterosexual individuals, and those in HIV-serodiscordant relationships.
• Successful implementation requires baseline laboratory assessment, initial counseling, and ongoing monitoring for adherence and potential side effects like nausea or elevated creatinine.

Conclusions:

• PrEP is a vital tool for reducing HIV transmission and is gaining acceptance in primary care.
• Addressing low provider knowledge is critical to expanding PrEP's reach to eligible patients.
• Clinical guidelines and toolkits are available to support the integration of PrEP into routine primary care.