Initiative Launches to Increase Access to PrEP in the Fight to End HIV

Today, HHS Secretary Alex Azar announced the launch of the Trump administration's effort to bring free doses of pre-exposure prophylaxis (PrEP) to at-risk populations, with the goal of sharply reducing new HIV infections over the next decade.

Called Ready, Set, PrEP, the program is part of the Trump Administration’s initiative, Ending the HIV Epidemic: A Plan for America, which was announced in the 2019 State of the Union Address. The plan seeks to reduce new HIV infections by 75% in 5 years and 90% by 2030. Through the coordination of several federal agencies (CDC, Health Resources and Services Administration, Indian Health Service, National Institutes of Health, Office of the HHS Assistant Secretary for Health, Substance Abuse and Mental Health Services Administration), administration officials will provide free PrEP to those who qualify, thereby increasing access to the medication and reducing new HIV infections. The President has asked Congress for $291 million to begin this initiative.¹

A preventive measure, PrEP is daily medication that can reduce the risk of contracting HIV by close to 99%, according to the CDC. Two PrEP medications are currently available: Truvada (emtricitabine/tenofovir disoproxil fumarate) is for anyone at risk for HIV through sex or injection drug use. Descovy (emtricitabine/tenofovir alafenamide) is for persons at risk through sex, but not receptive vaginal sex. However, only a small fraction of those who could benefit from PrEP receive the medication, despite more than 1 million being at risk for HIV.²

The program will be implemented in 2 phases:

• Phase I will focus on serving geographical “hotspots” with resources, expertise, and technology during the first 5 years of the program. These are the 48 counties; Washington, DC; and San Juan, Puerto Rico, where more than 50% of new HIV diagnoses between 2016 and 2017 occurred.
• Phase II will see the program expand nationwide, with the goal of maintaining new yearly infections at 3000.

There are also 4 key strategies involved:

1. Diagnose as soon as possible by making HIV testing easily accessible.
2. Treat infected persons quickly and effectively to suppress viral levels.
3. Prevent new transmissions through interventions.
4. Respond to potential HIV outbreaks rapidly in vulnerable areas.

“Ready, Set, PrEP is a historic expansion of access to HIV prevention medication and a major step forward in President Trump’s plan to end the HIV epidemic in America,” stated HHS Secretary Alex Azar in the press release announcing the launch .“Thanks to Ready, Set, PrEP, thousands of Americans who are at risk for HIV will now be able to protect themselves and their communities.”

Those receiving PrEP through the program must meet 3 criteria³:

1. They lack prescription drug coverage
2. They are HIV negative
3. They have a PrEP prescription

Through the more than 12,000 sites and 1400 health centers that will be serving the program, which can find here, HHS’s biggest partners in Ready, Set, PrEP are Gilead Sciences, CVS Health, Walgreens, and Rite Aid. Gilead will donate PrEP for up to 200,000 individuals each year through 2030, and starting March 30, the donated medication will be available through mail order from the participating pharmacies, who will also provide patient counseling and waive their dispensing fees. From now until then, however, the US government will be using the Gilead distribution network and those who qualify for the program can get their PrEP at the pharmacies.

“PrEP is highly effective in preventing HIV infection when taken as directed,” said Assistant Secretary for Health Brett P. Giroir, MD, also in the press release. “It is a critical tool for ending the HIV epidemic, but to make an impact it has to be available for people who need it most. Ready, Set, PrEP will increase access to this effective and preventive drug for people at risk.”

References

1. What is ‘Ending the HIV Epidemic: A Plan for America’? HHS/HIV.gov website. hiv.gov/federal-response/ending-the-hiv-epidemic/overview. Accessed December 3, 2019.

2. Ready, Set, PrEP. HHS/HIV.gov website. hiv.gov/federal-response/ending-the-hiv-epidemic/prep-program. Accessed December 3, 2019.

3. Ending the HIV Epidemic: Ready, Set, PrEP website. getyourprep.com/. Accessed December 3, 2019.