Ending the HIV Epidemic: How to Get Back on Track

In 2019, the United States government announced the Ending the HIV Epidemic plan. The ambitious initiative aims to end the HIV epidemic in the United States by 2030. The plan underscores the importance of testing, prevention, and treatment, seeking to reduce the number of new HIV infections by 75% by 2025 and at least 90% by 2030.¹

Unfortunately, the COVID-19 pandemic disrupted health care delivery and had a damaging impact on HIV services. Testing is a critical first step in accessing HIV prevention and care services.

According to the Centers for Disease Control and Prevention (CDC), from 2019 to 2020, new reported HIV diagnoses dropped by 17%. However, experts know this was not a result of a decrease in transmissions, but rather, fewer individuals being tested for HIV.

There was also a substantial decline in HIV testing during the same period among priority populations most impacted by HIV. That includes a nearly 50% reduction in tests among men who have sex with men, a 47.3% reduction among transgender persons, and 44.1% and 46.3% reductions among Black and Hispanic persons, respectively.²

So, how do we get efforts back on track? One way is to educate people about expanded access to HIV testing services and partner with community organizations to share information. Another is to drive awareness about the programs available for reducing the cost for prevention, treatment, and testing.

Pharmacists have an important role as community health experts and can help patients pick up their medication and stay on track with it. Additionally, we can enable pharmacies to provide HIV testing on-site, so they can directly connect patients to additional prevention services or treatment.

PrEP Uptake and Abandonment

One of the key advances in HIV prevention is pre-exposure prophylaxis (PrEP), a daily pill that can stop HIV from taking hold and spreading in the body. Since its approval on July 16, 2012, PrEP has proven to be highly effective in preventing HIV when taken as prescribed. In fact, PrEP reduces the risk of getting HIV from sex by about 99% for certain patient population with consistent adherence.³

However, only 25% of Americans who could benefit from PrEP were prescribed it in 2020. Furthermore, Black and Hispanic/Latino people account for most people for whom PrEP is recommended but have the lowest rates of PrEP use, with only 9% and 16%, respectively, receiving a prescription.^4,5

Additionally, recent data from the CDC show that those who need PrEP are not picking up their prescriptions from pharmacies. Notably, approximately 13% of new PrEP patients abandoned their medication at the pharmacy. Women were more likely than men to leave their pills behind, while 11% of people under the age of 25 and 14% of those ages 65 and up didn’t pick up their prescriptions.⁶

Patients without insurance and those paying cash did not pick up their PrEP medications 65% of the time. And nearly 1 in 3 people with insurance but who had a co-pay over $500 abandoned their PrEP prescription.⁵

Although there are programs—including Ready, Set, PrEP from the US Department of Health and Human Services—that offer PrEP for free for those who are uninsured and qualify, knowledge of these programs needs to be more widespread. Walgreens donates dispensing fees to further reduce the cost barrier in accessing PrEP; however, necessary physician visits and lab tests can still incur fees and cause financial burden.

In my time working as a pharmacist in Indiana and North Carolina, I saw first-hand some of the barriers my patients faced in picking up their medications, such as stigma, cost, and even transportation. The good news is that pharmacists can help raise awareness of programs and services to break down those barriers.

How Health Care Professionals Can Improve PrEP Adherence

PrEP abandonment presents an opportunity for interventions to increase uptake and support medication adherence. Cost is certainly an issue, but internal and external stigma and a lack of awareness are other barriers health care professionals must work to overcome. Connecting with patients is critical to understand which resources are needed to devise a plan and increase access to PrEP.

One important resource in this effort is your local pharmacist. As one of the most highly accessible health care providers across America, pharmacists play an important role in filling gaps in care and addressing social determinants of health with their clinical expertise and intimate knowledge of the communities they serve. In fact, nearly 60% of people said their pharmacist is more accessible to them than their physician, according to a recent survey conducted by OnePoll for Walgreens.

Pharmacists can help follow-up with patients to ensure they’re taking medications, such as PrEP, as prescribed. Pharmacies can go a step further and train their pharmacists to provide compassionate, culturally sensitive care to help mitigate any external or internal stigma patients may be facing, which is a model we use at Walgreens.

We invest in in-depth training of all our pharmacy team members on how to educate, counsel on treatment options, and support overall care within a stigma-free experience rooted in cultural competency. The program enables our team to be trusted advisors and experts in HIV prevention, treatment, and management within our communities. It’s also important for pharmacists to work closely with physicians and other care members to ensure patient needs are met holistically and they’re empowered to be part of the solution.

Pharmacists are also beneficial to their communities with their ability to prescribe certain medications. In fact, we’re currently piloting a program in Colorado in which Walgreens pharmacists can provide and prescribe treatment options if patients test negative for HIV and hope to expand this program to other regions. In addition, we currently have two clinic partnerships, one with the University of Miami Health System and the other with the Kind Clinic in Dallas, where patients can receive PrEP on-site.

As a pharmacist, it is incredibly important to me that communities know we are here for our patients.We have frequent conversations with clinical advocacy and community-based organizations to ensure our patients are receiving the resources they need to access and afford their medications.

Since 2011, we also have teamed up with Greater than AIDS, a public information initiative of the Kaiser Family Foundation, for a National HIV Testing Day event in which we partner with community-based organizations and health departments to provide free HIV testing in Walgreens locations nationwide.

Pharmacists can be that link to critical information patients might not have otherwise known, while also providing follow up care. Empowering pharmacists and expanding their role in the communities they serve are key to helping the United States get back on track to ending the HIV epidemic.

About the Author

Brad McElya, PharmD, Walgreens Director of Specialty Health Solutions, has been at Walgreens for over 20 years and in HIV treatment and prevention for four years. As a pharmacist who practiced in communities in Indiana and North Carolina, he knows firsthand the critical role the pharmacist plays as highly accessible healthcare providers across America. In his current role, he oversees Walgreens HIV treatment and prevention efforts and is involved in the trainings that Walgreens pharmacy teams undergo to provide compassionate and confidential care, including an understanding in cultural competency and enabling stigma-free experiences.

References

1. HIV.gov. What Is Ending the HIV Epidemic in the U.S.? https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview. Accessed August 2022.
2. Centers of Disease Control. HIV Testing Before and During the COVID-19 Pandemic — United States, 2019–2020. https://www.cdc.gov/mmwr/volumes/71/wr/mm7125a2.htm#:~:text=CDC%20analyzed%20data%20from%20four,with%20those%20reported%20in%202019. Accessed July 14, 2022.
3. Centers for Disease Control and Prevention. PrEP Effectiveness. https://www.cdc.gov/hiv/basics/prep/prep-effectiveness.html. Accessed July 14, 2022.
4. Centers for Disease Control and Prevention. HIV Surveillance Report, 2020; vol. 33. https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published May 2022. Accessed May 2022.
5. Centers for Disease Control and Prevention. PrEP for HIV Prevention in the U.S. https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/PrEP-for-hiv-prevention-in-the-US-factsheet.html. Accessed July 14, 2022
6. Huang, Y. L. A., Zhu, W., Carnes, N., & Hoover, K. W. (2022). Abandonment of Human Immunodeficiency Virus Preexposure Prophylaxis Prescriptions at Retail Pharmacies—United States, 2019. Clinical Infectious Diseases. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciac009/6501326?login=false. Accessed July 14, 2022.