Researchers have designed a home-based HIV pre-exposure prophylaxis, or PrEP, program that could reduce the number of routine clinic visits needed for PrEP users each year, alleviating the burden of care.
In a recent pilot study, PrEP@Home was highly accepted by men who have sex with men (MSM). More than one-third of participants said they would more likely persist in PrEP care if the program were available, Aaron J. Siegler, PhD, associate professor in the department of epidemiology at the Rollins School of Public Health, Emory University, and colleagues reported.
According to the researchers, PrEP is “an extraordinarily promising intervention.” However, quarterly monitoring assessments that are part of routine care can be problematic for patients and the health care system.
“Challenges such as lower access to car transportation disproportionately impact young and minority populations most impacted by HIV, and therefore may increase the burden for populations most in need of PrEP,” Siegler and colleagues wrote in Clinical Infectious Diseases. “With CDC estimating that over 1.2 million individuals have an indication for PrEP, the health care system would be burdened with nearly 5 million visits annually if PrEP was brought to scale.”
The PrEP@Home program is an integrated system that incorporates all components of a standard PrEP follow-up visit, including HIV and STD testing. It is designed to replace three out of four in-person visits that are recommended for PrEP users each year.
PrEP@Home was tested by 58 MSM PrEP users in the United States who replaced a single in-person follow-up visit with a home-care visit. The participants received a discreet testing kit in the mail that included a behavioral survey, four self-collection specimen tests, written and video instructions and a prepaid overnight mailer with shipping instructions.
Laboratory and behavior survey results were securely sent to the patient’s health care provider. Patients with positive, concerning or insufficient results were instructed to follow up with their provider. Those with adequate results could have their PrEP prescription renewed without an in-person visit.
Of the 55 participants who completed the pilot study, all but four submitted sufficient specimen samples needed for laboratory testing. Ninety-three percent of participants had their PrEP prescriptions renewed based on their laboratory and behavioral survey results.
Overall, most participants rated PrEP@Home as “acceptable” or “highly acceptable,” according to the researchers. More than 85% said they would use the kit again to replace a standard in-person visit, and more than 33% said they would more likely persist in PrEP care if PrEP@Home were available.
An additional benefit of the PrEP@Home kit is that it may potentially facilitate more frequent STD testing in this high-risk population, according to Siegler and colleagues. The feasibility, acceptability and cost-effectiveness of the intervention is being further assessed in a randomized clinical trial oversampling MSM who are highly impacted by HIV, including those who are black and young.
“Technological advances in high-speed connectivity, smartphones and laboratory testing are changing the landscape in which care can be delivered,” Siegler and colleagues concluded. “Future research should explore how to leverage such changes toward decreasing health disparities.” – by Stephanie Viguers
Disclosures: Siegler reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.