TAMPA, Fla. – Screening and recommending pre-exposure prophylaxis (PrEP) for people at risk for HIV exposure could be more successful if education and access to the prevention protocol are offered during testing for sexually transmitted infections (STIs).
Numbers matter, said Gabriela Brito, MSN, RN, ACRN, a researcher at the nonprofit CAN Community Health, headquartered in Sarasota, Fla. More people are seeking screening for STIs than are those actively seeking PrEP for HIV prevention.
“One in five people have been tested and diagnosed with an STI in 2021, so we can capture a large number of people from just STI testing and direct them to PrEP programs,” Brito said Medscape Medical News during a poster presentation here at the 2022 Association of Nurses in AIDS Care (ANAC) Annual Meeting. “So our initiative is pretty much about catching people at the point of care.”
Brito reported that as of September 30, 2022, 2174 patients were receiving PrEP services through one of 40 CAN Community Health clinics. Almost a third, 32%, were initially screened for free STI screening.
striving for better compliance
In some cases the problem is not beginning people on PrEP, it is keep them on the regime over time. The study found that 61% of people were still taking the drug after 6 months.
This number might have been even lower without CAN Community Health PrEP navigators. Of the 2174 patients, 63% work with a “PrEP Navigator”. These navigators help people access the drug and check in with them regularly to clarify any questions or reasons for non-compliance.
“If we see someone missing their appointments, our PrEP navigator will start reaching out to them to see what’s going on,” said study co-author Cheryl Netherly, BSW, LPN, ACLPN Medscape Medical News.
“It could be that they’ve moved to a different area or entered into a mutually monogamous relationship. They don’t know that telemedicine can keep them going if needed because sometimes it’s hard to get away from work [see] the doctor,” Netherly added. “So we’re finding ways to break through those barriers.”
More education required
Greater awareness of PrEP is another issue. “I think it’s really crucial to educate people and professionals. It can also help break down the stigma surrounding PrEP,” Brito said.
An analogy is when birth control pills first came out and some providers wouldn’t prescribe them because they feared women would be promiscuous, Netherly said.
“When PrEP first came out, there was a lot of that thinking,” Netherly added. “But PrEP doesn’t change your behavior. It just adds a layer of protection to behavior so you understand how to keep yourself healthy.”
A principle of basic care
The strategy of identifying potential PrEP candidates during STI screening is “extremely important,” said Myra L. Rutland, CPN, DNP, FNP-BC, home care nurse and director of infectious diseases and public relations at Spectrum Community Health Center in Philadelphia, Pennsylvania, he said when asked for comment. Rutland was not involved in the CAN Community Health study.
“This is basic care at its most general level. Primary care means you intervene before there’s a problem,” Rutland said.
“We have great medicines. Now, when patients stick to the drugs, they’re not just a little bit effective — they’re between 95% and 99% effective in preventing HIV,” she added.
The goal is to raise awareness that “if you contract any type of sexually transmitted infection, it means you may have been exposed to HIV,” Rutland said. “So why not offer PrEP? I do that with all my patients.”
Association of Nurses in AIDS Care (ANAC) Annual Meeting 2022. Summary P-10. Presented on November 17, 2022.
The study was independently supported. Brito and Rutland report no relevant financial relationships.
Damian McNamara is a staff writer based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology and critical care medicine. Follow Damian on Twitter: @MedReporter.
For more updates, follow Medscape on Facebook, TwitterInstagram, YouTube and LinkedIn.