Pre-Expsoure Prophylaxis

The Future of HIV PrEP Research

In part 2 of this 3-part episode, Jeffrey Kwong, DNP, MPH, ANP-BC, talks about how HIV pre-exposure prophylaxis (PrEP) has evolved over the years since becoming available for use in 2012 and the future of research on HIV PrEP.

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Listen to part 1 and part 3 of this 3-part episode.

Jeffrey Kwong, DNP, MPH, ANP-BC, is a professor in the division of advanced nursing practice at Rutgers School of Nursing (Newark, New Jersey). 


TRANSCRIPTION: 

Jessica Ganga: Hello everyone, and welcome to another installment of Podcasts360—your go-to resource for medical news and clinical updates. I’m your host Jessica Ganga with Consultant360 a multidisciplinary medical information network, along with your moderator, Jessica Bard.

When taken as prescribed, HIV Pre-exposure prophylaxis lowers the risk of getting HIV from sex by about 99 percent, according to the Centers for Disease Control and Prevention.  

Here with us today to speak about HIV Pre-exposure prophylaxis is Dr Jeffrey Kwong, who is a professor in the division of advanced nursing practice at Rutgers School of Nursing. Let’s listen in.

Jessica Ganga: Hello everyone, and welcome to another installment of Podcasts360—your go-to resource for medical news and clinical updates. I’m your host Jessica Ganga with Consultant360 a multidisciplinary medical information network, along with your moderator, Jessica Bard.

Nearly 37,000 people were diagnosed with HIV and an estimated 1.2 million people lived with HIV in the United States in 2019, according to the most recent data available from the Centers for Disease Control and Prevention.

Here with us today to speak about HIV Pre-exposure prophylaxis is Dr Jeffrey Kwong, who is a professor in the division of advanced nursing practice at Rutgers School of Nursing. Let’s listen in.

Jessica Bard: Thank you so much for joining us on the podcast today, Dr. Kwong, it's a pleasure to have you here. We're talking about HIV PrEP. How has PrEP evolved over the years?

Dr Jeffrey Kwong: Yeah, thanks, Jessica. That's a great question as well. So with regards to PrEP, several things have evolved over the last several years. So, initially, there was just one option available for PrEP and as of today in 2022, there are three FDA-approved options for preexposure prophylaxis. Two oral versions, and one long-term injectable option, which I think is quite exciting. And so, one of the great things about PrEP is that now we have different options for different people, and there are choices that we can have. So hopefully there will be some other options coming down the line. But the great thing is that there's options. There are now generic options available. So that has also helped make it a little bit more accessible for folks.

Jessica Bard: What would you say is next for research on PrEP?

Dr Jeffrey Kwong: Yeah, so there's a couple of exciting things in the forefront in terms of preexposure prophylaxis or PrEP. So one, which I already alluded to a little bit is this whole concept of long-acting options. So right now, there is just one option that's available, that's long-acting. And long-acting here is about every eight weeks. There are other long-acting options that can be, potentially they're looking at six months or so. And similar to long-acting reversible contraceptive options, there are studies looking at implantable options for PrEP, where there would be a slow-release device that's implanted under the skin, that can slowly release medication. So again, people won't necessarily need to take a pill every day or get an injection every couple of months.

They are also looking at combination PrEP and contraceptive options. So sort of multi-use devices that will be available for people. So it's really exciting to sort of think about the different options that are on the horizon and just in the span of 10 years or so, we went from one to three options. And so I'm really excited to see what'll happen over the next 10 years.

Jessica Bard: Right, you mentioned that it's great to have choices. Why would you say it's important to expand available PrEP regimens and preventive technologies for diverse, at-risk populations?

Dr Jeffrey Kwong: Sure. So when we think about things like prevention and specifically HIV prevention, we know that people are at risk for HIV through various factors, and there's not one size that fits all if you will. So the fact that people having a choice with regards to if they are pill takers and they're not people who like to get an injection or they have needle phobia or they're concerned about having something that's long-acting on their options. For those people, for people who may have issues with adherence, who may not necessarily be taking medications every day. They may be challenged by things such as their work schedule or their travel schedule, or just the fact that they don't have a place to store their medications at home, every day. They have options. They can do the injectable options.

For people who may not want to disclose that they're taking PrEP to their partner, because it may cause other interpersonal issues within their relationship that they don't want to necessarily discuss with their partner. They have options to use PrEP. So again, everybody has a different situation and I really think PrEP is an individual choice. And so this is something that allows people the choice to pick the intervention or the solution that works best for them.

Jessica Bard: When talking specifically about the primary care setting, what are the overall take-home messages for clinicians in the primary care setting that people need to know from our conversation today?

Dr Jeffrey Kwong: For people in the primary care setting, I think a couple of things about PrEP is really relevant. So one is specifically just with regards to HIV prevention. So when we think about primary care, when we think about providing holistic care, sexual health and sex is a part of that. And unfortunately, oftentimes many people tend to shy away from it or they don't explore that area a lot. And so PrEP provides an opportunity to have a discussion about sex and sexual health and sexual practices. That's one option that's great for primary care providers.

The other thing is for PrEP itself, for people who are on PrEP. Now, the guidelines currently recommend that most people on PrEP come in and be seen on a regular basis, about every three months or so for routine testing and screening. Now, when we think about populations that may utilize PrEP, say a younger person in their 20s or 30s, for instance. That's a population that may not, under other circumstances, may not necessarily come to a primary care provider because they're otherwise young and healthy and they don't feel like they need to. But by making them come in every three months, it's a great opportunity to talk about not just sexual health, that is the focus of the PrEP follow up, but you can also follow up on immunizations. You can check on their blood pressure, you can check on other things like diet and exercise. You can talk about mental health. You can talk about other pieces, which are also primary care. So in some ways, PrEP is an entree to primary care and primary care is an entree to HIV prevention.

Jessica Bard: Is there anything else that you'd like to add today, Dr. Kwong?

Dr Jeffrey Kwong: I'll just reiterate the same message I did the last time, which is that everybody has a part to play in HIV prevention and just the one small step of providing and offering, or at least referring folks to PrEP, is a key part of that initiative. And we can all play a role in ending the epidemic.

Jessica Bard: Well said, thank you so much for joining us on the podcast today.

Dr Jeffrey Kwong: Thank you.