PrEP—Still Controversial, but New Data Validate the Public Health Benefit

Pre-exposure prophylaxis against HIV infection (PrEP) has yet to gain traction in urgent care centers—even among operators who recognize the public health benefit. Some have moral qualms about PrEP, believing that offering an added layer of protection encourages high-risk behavior among those already at the greatest risk (namely, men who have sex with men [MSM], heterosexually active men and women, and people who inject drugs). Others are concerned about reimbursements and the complexities of the regimen. And new data published in JAMA reinforce the latter point, but also the potential to stem the spread of HIV. Researchers pooled data from 14 randomized control trials, eight observational studies, and seven studies of diagnostic accuracy—all told, encompassing 55,000 subjects. They found that PrEP was associated with an absolute risk reduction of 67%. However, its effectiveness decreased when adherence lagged—and it varied widely among MSM, from 22% to 90%. Still, the current state of the evidence is such that the U.S. Preventive Services Task Force “recommends offering PrEP with effective antiretroviral therapy to persons at high risk of HIV acquisition.” If you’re curious about the possible application for PrEP in urgent care, you should read Initiating PrEP services in Urgent Care in the JUCM archive.