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The need for a health equity framework in next-generation pre-exposure prophylaxis implementation.
Pablo K Valente1, Don Operario2, Jack Rusley3
1Department of Allied Health Sciences, University of Connecticut, Waterbury, CT, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
The Lancet. HIV
|February 27, 2023
Summary
Pre-exposure prophylaxis (PrEP) prevents HIV transmission, but access disparities persist. New long-acting PrEP options could widen these gaps if not implemented equitably, necessitating a framework to ensure access for all.
Area of Science:
- Public Health
- Epidemiology
- Health Equity
Background:
- Pre-exposure prophylaxis (PrEP) is crucial for HIV prevention but access disparities contribute to unequal HIV burden in the USA.
- Next-generation PrEP formulations, like long-acting cabotegravir, offer improved adherence but risk exacerbating disparities if not equitably rolled out.
Purpose of the Study:
- To propose an equity-promoting framework for implementing daily oral and next-generation PrEP in the USA.
- To address disparities in HIV prevention care and reduce the overall HIV burden.
Main Methods:
- Utilized US epidemiological data.
- Applied the Theory of Fundamental Causes of Health Disparities.
- Proposed a multilevel framework for PrEP implementation.
Main Results:
- Identified potential for next-generation PrEP to widen existing HIV disparities.
- Outlined multilevel strategies including demand generation, service expansion, and barrier reduction.
Conclusions:
- An equity-promoting framework is essential for implementing both daily oral and next-generation PrEP.
- Multilevel interventions are needed to ensure equitable access to HIV prevention options.
- Addressing structural and financial barriers is key to reducing HIV transmission and disparities.
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