Implementing the PrEP & PEP Toolkit
In this video, Colleen F. Kelley, MD, MPH, speaks about incorporating pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) into clinical practice, including strategies for clinicians, current knowledge gaps, and what is next for research on PrEP and PEP to improve access to patients. Dr Kelley also presented on this topic at the Conference on Retroviruses and Opportunistic Infections (CROI) 2023 during a session titled “Implementing the PrEP and PEP Toolkit.”
Kelley CF. Implementing the PrEP and PEP Toolkit. Talk presented at: Conference on Retroviruses and Opportunistic Infections (CROI); February 19-22, 2023; Seattle, WA. Accessed March 10, 2023. https://www.croiconference.org/preliminary-agenda/
Colleen F. Kelley, MD, MPH, is a faculty member in the Division of Infectious Diseases at Emory University and in the Department of Epidemiology, Rollins School of Public Health (Atlanta, GA).
Colleen F. Kelley, MD, MPH: Hi, my name is Colleen Kelley. I'm an associate professor of medicine at Emory University School of Medicine, and I'm a specialist in infectious diseases with a particular interest in the prevention of HIV.
Please provide an overview of your session at CROI 2023: “Implementing the PrEP & PEP Toolkit.”
In this talk, I reviewed the current status of post-exposure prophylaxis, or PEP, and pre-exposure prophylaxis, or PrEp. We are currently at a very exciting time in HIV prevention where we have multiple options that people can use for biomedical prevention to prevent HIV. We are also on the cusp of having the potential for many more exciting options that people will be able to choose from that best suit their HIV prevention needs.
In this talk, we reviewed the under-utilization of post-exposure prophylaxis and how we might improve upon that, as well as daily oral PrEp, on-demand PrEp, injectable cabotegravir, the Dapivirine ring, as well as TAF/FTC, which are all regimens that people can choose between to prevent HIV infection.o
How has the incorporation PrEP & PEP into clinical practice evolved in recent years and where are we today?
Well, I think today we are at a place where increasing uptake of oral tenofovir-based pre-exposure prophylaxis is being seen across the globe. Unfortunately, it is not necessarily concentrated in populations that are most likely to benefit. We do see significant disparities, particularly in the US in who is using oral daily PrEp compared to who's acquiring HIV. That's to say that we know that, in the US, especially, the highest rates of HIV infection occur among Black and Latinx people, and yet PrEp is underutilized in those populations. Also, globally, while there is increasing uptake of PrEp everywhere, it is concentrated in South Africa and other countries in Sub-Saharan Africa and is not necessarily uniform across the world.
What are some strategies and action items for incorporating PrEP & PEP into clinical practice?
First, people have tried a lot of different strategies and a lot were motivated by the COVID pandemic. Things like PrEp telehealth and mobile clinics are ways that people are increasing access to PrEp. There are also M-health, or mobile health, applications that people are using to help people start PrEp and then persist on PrEp over time. There are lots of things out there, the different models that people are utilizing to try and increase access to PrEp. And so, it remains to be seen which will be most successful and most easy to implement even in resource-poor settings.
What are the current knowledge gaps and what is next for research on PrEP & PEP to improve access?
I think we need to understand how having a choice of different regimens, which we have been clamoring for as an HIV prevention field, how having a choice will increase the complexity of delivering PrEp within our clinical contexts, but also determine how having a choice of different regimens will help people persist on PrEp over time. We know that with daily oral PrEp great number of people discontinue after taking it for a few months. It will be very interesting to see if we're able to offer another option, another choice, if it allows people to use PrEp for more prolonged periods of time, which is really important when we think about periods of HIV risk.
Did any research presented at CROI 2023 surprise you or is there anything exciting that you learned that you would like to share?
Yeah, absolutely. For me, I think the most important and exciting findings were around the prevention of sexually transmitted infections. We really need to think about holistic sexual health, and when we think about both HIV as well as sexually transmitted infections because the exposures are very similar and the same people who are acquiring HIV are also acquiring other STIs. And so, if we can think about how we can best keep people healthy and prevent all the infections that they might be exposed to. And so, doxycycline post-exposure prophylaxis, there was a lot of information presented on doxycycline post-exposure prophylaxis as well as the meningitis B vaccine to prevent gonorrhea. And so, it's really intriguing to think how now we'll not only have multiple options for pre-exposure prophylaxis, but we also will need to think about incorporating prevention for other sexually transmitted infections into our clinical practices.