Improved Access to PrEP Needed for HIV Prevention in US Military Services

Approximately 350 new HIV infections are diagnosed in US military service members each year, with most infections acquired within the United States and among men who have sex with men (MSM), according to a study in the CDC’s Morbidity and Mortality Weekly Report. Access to pre-exposure prophylaxis (PrEP) is essential to an effective HIV prevention strategy, however there are many barriers to such preventive measures, the study noted.

Limited knowledge and experience with prescribing PrEP among military health care providers and lack of resources at smaller military treatment centers are among the barriers that can hinder members’ access to PrEP services, according to the report.

The researchers asked 4217 Army, Navy, and Air Force health care providers to respond to a web-based survey to self-rate their knowledge of PrEP from 2015 to 2017. Among the 1599 respondents, including 1190 primary care providers, 49% rated their knowledge of PrEP as poor. Additionally, only 29% reported ever having prescribed PrEP. Common health care provider concerns reported in the survey included medication adverse effects, compliance, and a need for more clear evidence of safety or efficacy.

Despite this, 68% of health care provider respondents endorsed provision of PrEP in the military health care system.

Military health systems and service records were reviewed to describe HIV PrEP use among military personnel. According to the data, among 769 service members prescribed PrEP from February 1, 2014, to June 10, 2016, 87% were MSM. Additionally, 19% were black men and 42% were aged less than 28 years.

Most patients using PrEP are receiving Truvada from major military centers that refer them to infectious disease specialists.

Despite the universal access to care afforded to service members by the military health care system, there is a need to improve and expand access to PrEP for patients at the highest risk of HIV infection.

“Increased capacity through provider education and expanded access to the requisite pharmacy and laboratory support services are necessary to meet the anticipated future demand for PrEP and ensure effective delivery of these services in the primary care setting,” the researchers wrote.

The researchers suggested reducing barriers to care by allowing patients to self-refer for PrEP evaluations, which is being done at several locations with infectious disease specialists.

The US Department of Defense is also developing a new policy that includes initiatives designed to improve health care provider education and standardize pharmacy and laboratory service delivery at all military treatment facilities.

References

Blaylock JM, Hakre S, Okulicz JF, et al. HIV Preexposure Prophylaxis in the U.S. Military Services — 2014—2016. MMWR. 2018. 67(20);569-574. https://www.cdc.gov/mmwr/volumes/67/wr/mm6720a1.htm?s_cid=mm6720a1_w.