Earlier this month at a national summit on HIV pre-exposure prophylaxis or PrEP, I had the opportunity to share some highlights of federal activities to support scaling up this important HIV prevention tool as well as my personal perspectives as a PrEP user.
The NMAC HIV PrEP Summit brought together a diverse group of 600 individuals including community members, healthcare providers, researchers, industry partners, health department staff, and a few fellow feds.
New NHAS PrEP Indicator Calls for 500% Increase in Use
In her plenary session remarks, Dr. Amy Lansky, Director of the White House Office of National AIDS Policy (ONAP), highlighted the role that PrEP plays in achieving the National HIV/AIDS Strategy (NHAS) goal of reducing new HIV infections. She underscored the importance of full access to PrEP services for those for whom it is appropriate and desired with support for medication adherence for those using PrEP.
Amy introduced a new, PrEP-focused developmental indicator to the existing group of indicators being used to monitor annual progress toward achieving the goals of the Strategy. The new PrEP indicator measures the number of adults prescribed PrEP and sets a target for an increase of at least 500 percent in that number, from the baseline of 9,375 persons in 2014 to 56,250 persons in 2020. Efforts to reach that target are already underway, she noted, observing that in the NHAS Federal Action Plan several agencies had previously committed to a variety of PrEP-focused activities. These included efforts over recent months by a federal workgroup to compile a list of key federal PrEP-related activities and develop a framework to guide planning efforts.
Federal PrEP Framework
In a breakout session about Federal efforts and opportunities related to PrEP, I joined CDC's Dr. Dawn Smith and HRSA's Ms. Antigone Dempsey who each shared several examples of what their respective agencies have already undertaken and are planning to soon do in support of expanding access to and use of PrEP. During my presentation, I was able to elaborate on the new federal HIV PrEP Framework that Amy had announced during her plenary remarks.
The Framework serves as a blueprint for the federal government's response for scaling up PrEP. It defines seven essential components of a comprehensive federal approach to PrEP. Within each essential component, we highlight a number of selected federal activities that have been completed or are currently underway. The framework will be used to plan future federal PrEP efforts and assess progress. To learn more about the Framework and what is going on across the federal government to support the scale up of PrEP, check out the new AIDS.gov page about it.
Available prevention strategies vary in terms of their effectiveness and the ability of a given person to use the method consistently. Even if a given strategy is the most effective, it will not provide much protection if it is not used consistently. This means that we should work to ensure that everyone seeking to prevent transmitting or acquiring HIV infection has the opportunity to use the prevention options that work best them. CDC's HIV Risk Reduction Tool provides a way for people to assess which prevention strategies would provide the highest levels of protection.
As we all work to scale up PrEP, a relatively new HIV prevention tool, our efforts can benefit from "real talk." That was one of the great values of the NMAC PrEP Summit, which had assembled voices from diverse experiences and sectors. With that in mind, I took a moment during our discussion about federal activities to describe my personal perspective as a PrEP user and the difficulties my partner recently had in accessing health insurance and PrEP. I offered some reflections from our lived experiences together that not only inspire my commitment to the fight against HIV but might also inform activities to increase awareness, uptake, and adherence to PrEP.
Successfully scaling up PrEP as well as achieving our national goals for viral suppression will put us on a path for realizing the vision of the NHAS. Doing so requires a comprehensive effort from the federal government including tools such as the new NHAS PrEP Indictor and the HIV PrEP Framework. However, federal efforts alone are not enough. Complementary and collaborative efforts with healthcare providers and systems, payers, health departments, communities, researchers, and industry are equally vital. The PrEP Summit offered promising signals on many of those fronts.
Nathan Fecik, M.P.H. is public health advisor at the Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services.