Over the past few months, San Francisco based organizations HIVE (formerly BAPAC) and getSFcba, partnered with the National Clinical Training Center for Family Planning (NCTCFP) to help fill a gap ? the slow uptake of PrEP among cis women in the United States.
Here?s the deal: One in five new HIV diagnoses in the U.S. are among cis women. Black women make up approximately 64% of these new diagnoses while only accounting for 13% of the U.S. female population. Can PrEP prevent HIV among all women? Can PrEP reduce the grave racial/ethnic disparities seen in rates of HIV acquisition in women?
PrEP was approved as a safe and effective HIV prevention tool in 2012. ?In November 2015, the CDC released a Morbidity & Mortality Weekly Report (MMWR) estimating that there are 468,000 HIV vulnerable women in the United States for whom PrEP is indicated. By the end of 2015, only about 19,000 U.S. women had ever been prescribed PrEP. That number has plateaued since then. ?Therefore, we need to figure out how to increase PrEP awareness and access for all women.
Women are diverse, and have diverse needs and preferences. One size does not fit all. One thing we do know is that more than 40% of women rely exclusively on reproductive health clinics to access health care and choose family planning clinics because of respectful staff, confidential care, free or low cost services, and providers who are knowledgeable about women?s health. We also know that family planning clinics see a racially/ethnically diverse population. ?The 2015 National Summary of the Family Planning Annual Report estimates that 64% of family planning clients were non-white.
Women?s health care providers are uniquely positioned to screen for, counsel about and offer PrEP. ?Moreover, family planning providers are equipped to utilize a woman-centered approach when working with patients. ?Yet, a 2016 survey of family planning providers demonstrated that of 342 potential PrEP prescribers, only 38% correctly defined PrEP. ?Many providers identified lack of training as the main barrier to PrEP implementation. ?87% wanted further PrEP education.
In comes the collaboration between HIVE, getSFcba and NCTCFP. ?This group wanted to provide the family planning community with resources and tools to rollout PrEP in sites across the U.S. and to do it NOW! Together, we curated, published, disseminated and evaluated the Family Planning Provider PrEP Toolkit. ?The toolkit includes tips on eligibility, reimbursement, clinic flow, roles, and many other nuts and bolts ?what you need to know to operationalize PrEP.
But, the toolkit goes a step further. ?It encourages conversation and learning. ?It encourages relationship building and shared decision-making when we interact with patients. It pushes us all to examine our role in bringing PrEP to cis women nationwide ? to step up and be champions within our clinics. It also pushes us to think about how best to support our patients and all PrEP users as they step forward and tell their stories.
Work on the Family Planning Provider PrEP Toolkit led to the creation of a new webpage offering ideas and resources on how to tackle the widening racial/ethnic disparities in HIV acquisition and PrEP use.? The page provides support resources for everyone working to implement PrEP, from providers to patients; after all, we are not alone as clinicians, advocates or consumers. There are capacity building resources, phone consultation lines, social media groups. The toolkit?s message is clear: we must do this, we must do this now, and we have what it takes to do it.
PrEP has the potential to turn the tide of new HIV diagnoses the same way that treatment as prevention (TasP) can eliminate HIV transmission. But we must spread the word. People living with HIV must know that Undetectable = Untransmittable and people affected by HIV must know that PrEP is an option for them.
There is much work that is underway and much that is yet to be done to assure all women have access to PrEP. Join us!
Dominika Seidman, Zuckerberg San Francisco General Hospital Division; Obstetrics, Gynecology & Reproductive Sciences at University of California San Francisco
Shannon Weber, HIVE, PleasePrEPMe.org
Yamini Oseguera-Bhatnagar, HIVE