Maximizing impact and growth: the power of PrEP for HIV in primary care

In the battle against the HIV epidemic, primary care physicians (PCPs) stand at the forefront of a transformative opportunity. Beyond the profound human impact, the lifetime treatment expenses for an HIV infection surpass $500,000, leading to a significant rise in health care expenditures, estimated at $175 billion over the last 10 years (based on an average of 35,000 new infections annually).

Amidst the complexities of managing diverse health needs, the role of PCPs – encompassing family practitioners, pediatricians, geriatricians, internists, emergency doctors, and OB/GYNs – extends beyond traditional boundaries, touching upon a critical area: HIV prevention and care. This intersection represents not just a medical responsibility but also a societal imperative, particularly for those in independent practices.

Pre-exposure Prophylaxis (PrEP) can be taken either as a daily pill or as an injection every two months given by a provider. When taken as prescribed, it is highly effective, reducing the risk of getting HIV from sex by about 99%. By the end of 2025, a biannual PrEP injectable is anticipated to be available.

The evolution of the HIV epidemic demands a reevaluation of our collective approach to health care. While remarkable biomedical advances and the introduction of PrEP have significantly altered the landscape of HIV prevention, a glaring disparity persists in the accessibility and utilization of these advances. This is especially true among underserved populations, including women, Black Americans, and Hispanic/Latino communities, who continue to bear a disproportionate burden of the epidemic.

Empowering primary care to lead the charge in HIV prevention and care

Primary care physicians are uniquely positioned to bridge these gaps. The trust and continuity inherent in the patient-PCP relationship provide a foundational platform for comprehensive HIV prevention and management. However, this potential remains largely untapped, particularly in the realm of PrEP awareness and prescription.

Statistics underscore the urgency: Despite PrEP's efficacy, a significant proportion of at-risk individuals remain uninformed or under prescribed, particularly among Black and Hispanic/Latino populations and women. The disparity in PrEP coverage – 94% of White individuals who could benefit from PrEP have been prescribed it, compared to just 13% of Black and 24% of Hispanic/Latino individuals – highlights a pressing need for PCPs to actively engage in patient education and advocacy. Additionally, only 10% of women who stand to gain from PrEP are currently utilizing it.

Integrating HIV prevention into primary care

For PCPs, especially those operating within independent practices, integrating HIV prevention into routine care represents both a challenge and an opportunity. It demands a proactive approach to patient education, regular screening, and the destigmatization of HIV testing and treatment. By normalizing conversations around sexual health and HIV risk assessment, PCPs can play a pivotal role in demystifying PrEP and expanding its reach.

PrEP patients can become repeat patients for primary care providers, as initiating PrEP care opens the door to other routine health services, establishing a continuum of care. Currently, patients on PrEP pills need to visit their provider every three months for refills and lab tests, while those using the injectable form require a visit every two months Initiating PrEP care serves as an entry point for patients into the health care system, where the initial focus on HIV prevention can naturally extend into broader health discussions and screenings. This approach fosters a deeper patient-provider relationship, encouraging individuals to return for various health needs beyond PrEP, from routine check-ups to vaccinations and chronic disease management.

Practical suggestions for PCPs

Routine sexually transmitted infections (STI) and HIV screening: Incorporate HIV screening as a standard part of adult and adolescent health care evaluations, regardless of perceived risk. Every sexually active patient should be informed about PrEP, particularly following a positive STI test result. Contracting HIV increases by 300% in individuals with rectal chlamydia or gonorrhea.

Educational outreach: Leverage patient visits as opportunities to educate about HIV prevention, specifically PrEP, addressing misconceptions and highlighting its relevance to diverse populations.

Technology integration: Embrace innovative solutions like conversational artificial intelligence (AI) to enhance patient education and engagement, making resources accessible while patients are in the waiting room and outside of traditional clinic hours.

Collaboration and training: Engage in continuous education about the latest in HIV care and prevention, and collaborate with specialists to ensure comprehensive care for patients living with or at risk of HIV. For providers wanting to learn more about PrEP basics both the University of Washington and healthhiv.org have created a free online HIV PrEP Curriculum for health care professionals.

Nevertheless, if your practice is not ideally equipped to manage a patient's PrEP regimen, telehealth providers such as Nurx have enhanced the accessibility of HIV prevention care. They overcome typical obstacles like transportation and time restrictions by delivering PrEP and associated lab tests directly to a patient's doorstep.

As primary care physicians, your commitment to patient care extends to all aspects of health, encompassing the critical yet often overlooked domain of HIV prevention and care. By actively engaging in this arena, PCPs can significantly influence the trajectory of the HIV epidemic, advancing not only the health of their patients but also the well-being of the broader community. In doing so, we affirm the indispensable role of primary care in navigating the complexities of modern health care challenges, driving forward a future where HIV no longer poses a public health threat.

Ramin Bastani is the founder and CEO of Healthvana, a technology company dedicated to making life better for patients. Under his leadership, the company’s patient engagement platform for health care providers has delivered more than 50 million health records to patients across the U.S.

Gabriella Palmeri is a digital health expert with a decade of experience in developing innovative solutions to close gaps and eliminate stigma in sexual health care. She spearheads Healthvana's new business ventures and plays a key role in the recent initiatives that leverage patient-facing generative AI to improve HIV/STI prevention and care.