TAMPA, Florida — Screening and recommending preexposure prophylaxis (PrEP) to people at risk for HIV exposure could be more successful if education and access to the preventive protocol is offered during testing for sexually transmitted infections (STIs).
It comes down to numbers, said Gabriela Brito, MSN, RN, ACRN, a researcher at nonprofit CAN Community Health, headquartered in Sarasota, Florida. More people seek screening for STIs compared with those who actively seek PrEP for HIV prevention.
“One out of five individuals got tested and were diagnosed with an STI in 2021, so we can capture a huge amount of people just from STI testing and direct them to PrEP programs,” Brito told Medscape Medical News during a poster presentation here at the Association of Nurses in AIDS Care (ANAC) 2022 Annual Meeting. “So our initiative is pretty much about capturing 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. Nearly one third, 32%, were initially seen for free STI screening.
Striving for Better Adherence
In some cases, the issue is not starting people on PrEP, it’s keeping them on the regimen over time. The study revealed that 61% of the people were still taking the medication at 6 months.
This figure 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 medication and check in with them on a regular basis to address any questions or reasons behind a lack of adherence.
“If we’re seeing someone’s missing their appointments, our PrEP navigator will start reaching out to them to see what’s going on,” study coauthor Cheryl Netherly, BSW, LPN, ACLPN, told Medscape Medical News.
“It could be they moved to a different area or entered a mutually monogamous relationship. They don’t realize they can continue through telehealth if they need to, because sometimes it is hard to get off of work to go [see] the doctor,” Netherly added. “So we find ways to break those barriers.”
More Education Needed
Greater awareness around PrEP is another issue. “I think educating people and educating professionals, it’s really crucial. It can also help diminish the stigma around PrEP,” Brito said.
An analogy is when birth control pills first came out, and some providers would not prescribe them because they were concerned women would be promiscuous, Netherly said.
“When PrEP first came out, there was a lot of that same mindset,” Netherly added. “But PrEP does not change your behavior. It’s just adding a layer of protection to the behavior, so you can understand how to keep yourself healthy.”
A Primary Care Tenet
The strategy of identifying potential PrEP candidates during STI screening is “extremely important,” Myra L. Rutland, CPN, DNP, FNP-BC, a family nurse practitioner and director for infectious disease and community outreach at Spectrum Community Health Center in Philadelphia, Pennsylvania, said when asked to comment. Rutland was not involved in the CAN Community Health study.
“This is primary care at its most generic level. Primary care means that you intervene before there’s a problem,” Rutland said.
“We have great medications. Now if patients are adherent to the medication, they are not just a little bit effective — they are between 95% and 99% effective at preventing HIV,” she added.
The goal is to increase awareness that “if you contract any type of sexual transmitted infection…that means that perhaps you may have come in contact with HIV,” Rutland said. “So why not offer PrEP? I do that with all of my patients.”
Association of Nurses in AIDS Care (ANAC) 2022 Annual Meeting. Abstract P-10. Presented November 17, 2022.
The study was independently supported. Brito and Rutland report no relevant financial relationships.
Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.