One of the main challenges of PrEP is the marked drop in use over time. This is most evident in settings where there are costs for the medication, testing or service provision, such as in the USA, where in different settings persistence dropped considerably over 3-12 months and to as low as 25% at 1 year in one setting.
HIV infection was observed to be high if PrEP is stopped.
Some of the newer PrEP methods in the pipeline include:
- The Dapivirine flexible vaginal ring- inserted monthly
- Long-acting injectable Cabotegravir with t1/2 of 40-65 days
- Long- acting implants- various agents in development, lasting months to years
Some of the important points for my own practice that I take from this:
- The importance of using strategies that help to optimize adherence and persistence with PrEP e.g good personal engagement with the patient, recall / reminder systems
- The importance of opportunistic identification of high risk patients and prompt initiation of PrEP
Author bio:
Dr Jane Hunt is a GP working in high case-load HIV practice at Holdsworth House Medical Practice (HHMP) in Darlinghurst N.S.W.
