Overcoming structural barriers to diffusion of HIV pre-exposure prophylaxis

Authors

Manya Magnus, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Hannah Yellin, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Kayley Langlands, Division of Infectious Diseases, Medical Faculty Associates, George Washington University, Washington, DC, USA.
Madhu Balachandran, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Melissa Turner, Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC, USA.
Jeanne Jordan, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Daniel Ramin, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Irene Kuo, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Marc Siegel, Division of Infectious Diseases, Medical Faculty Associates, George Washington University, Washington, DC, USA.

Document Type

Journal Article

Publication Date

1-1-2023

Journal

The journal of medicine access

Volume

7

DOI

10.1177/27550834231214958

Keywords

HIV prevention; Pre-exposure prophylaxis; providers; regulatory pathways; structural barriers

Abstract

HIV prevention with antiretroviral medication in the form of pre-exposure prophylaxis (PrEP) offers a critical tool to halt the HIV pandemic. Barriers to PrEP access across drug types, formulations, and delivery systems share remarkable commonalities and are likely to be generalizable to future novel PrEP strategies. Appreciation of these barriers allows for planning earlier in the drug-development pathway rather than waiting for the demonstration of efficacy. The purpose of this article is to propose a core set of considerations that should be included in the drug-development process for future PrEP interventions. A literature synthesis of key barriers to PrEP uptake in the United States was conducted to elucidate commonalities across PrEP agents and delivery methods. Based on the published literature, we divided challenges into three main categories of structural barriers: (1) provider and clinic characteristics; (2) cost considerations; and (3) disparities and social constructs, with potential solutions provided for each. Pragmatic strategies for examining and overcoming these barriers before future PrEP regulatory approval are recommended. If these strategies are considered well before the time of commercial availability, the potential for PrEP to interrupt the HIV pandemic will be greatly enhanced.

APA Citation

Magnus, Manya; Yellin, Hannah; Langlands, Kayley; Balachandran, Madhu; Turner, Melissa; Jordan, Jeanne; Ramin, Daniel; Kuo, Irene; and Siegel, Marc, "Overcoming structural barriers to diffusion of HIV pre-exposure prophylaxis" (2023). GW Authored Works. Paper 3998.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3998

Department

Medicine