Proposed policies and funding efforts could end the HIV epidemic, experts say

Researchers from the Johns Hopkins Bloomberg School of Public Health contributed to a special issue of the Journal of Law, Medicine and Ethicsincluding studies and commentary that support a national program to improve access to pre-exposure prophylaxis, or PrEP, a drug that prevents the spread of HIV.

The policy proposal for a national PrEP program was released in December 2021 by researchers at Johns Hopkins University, including the Bloomberg School, and national HIV policy experts. The proposal, “Funding and Providing Pre-Exposure Prophylaxis PrEP to End the HIV Epidemic,” outlines a new funding and delivery system that moves away from the use of expensive brand name drugs and expands the number of PrEP access points for uninsured, underinsured, and Medicaid-covered people.

President Biden’s 2023 budget proposal, released in March, includes $9.8 billion in funding over 10 years for a national PrEP program.

To maximize the benefits of a national PrEP program, the academic proposal recommends that:

  • Government buys PrEP drugs to get stable supply at low cost
  • Clinicians have new options to provide same-day on-site PrEP with better access to lab testing
  • People without regular health care can access PrEP in community settings, such as domestic violence centers and street outreach programs, and through telehealth

The special issue, published online today, includes research papers and commentary that address important considerations outlined in the policy proposal. These include how to approach private insurance and Medicaid coverage for PrEP, increase access for vulnerable communities that need PrEP the most, and understand how generic options can offset financial burdens.

“For more than a decade, PrEP has been available as a very effective tool to curb the HIV epidemic, but it remains out of reach for many Americans,” says Joshua Sharfstein, associate dean of health practice. public and community engagement and a practical professor in the Department of Health Policy and Management at the Bloomberg School. “It’s about equity. Until we close the huge gaps in income, race and ethnicity, age and location, we will struggle to end the HIV epidemic. .”

In 2012, the United States Food and Drug Administration approved the use of prescription drugs to prevent the spread of HIV. PrEP is taken by people at high risk of contracting HIV and can reduce transmission by up to 99%. However, only about a quarter of people who could benefit from PrEP received a prescription in 2020. Uptake of PrEP is even lower in black and Hispanic populations, with less than 9% of black people receiving a prescription and less than 16% of Hispanics/Latinos. people. Significant difficulties in funding and delivering PrEP account for this disparity.

“For more than a decade, PrEP has been available as a very effective tool to curb the HIV epidemic, yet it remains out of reach for many Americans.”

Joshua Sharfstein

Bloomberg School of Public Health

A study in the special issue, led by researchers at the Johns Hopkins Bloomberg School of Public Health, found that generic PrEP offers a promising solution by addressing financial barriers to drug access. Researchers found that after generic PrEP was introduced to the market, the price per dose of generic PrEP was only $1, compared to $28 per dose of brand name PrEP. Overall PrEP use did not appear to increase over the study period.

“So far, greater access to low-cost, generic PrEP drugs does not appear to have significantly expanded their use,” says Jeromie Ballreich, science assistant in the Department of Health Policy and Management and senior author of the paper. ‘study. “Policymakers now have the option of purchasing generic PrEP at a discount of more than 90% compared to brand name PrEP. Bulk purchasing could be implemented as part of a national strategy to increase the use of PrEP.”

Another paper suggests that the national PrEP program can model other public health responses like that of a measles outbreak in the late 1980s that led to the federal Vaccines for Children program where the government purchased vaccines for children covered by Medicaid or who were uninsured. The authors make the argument that purchasing medical technologies (drugs, devices, etc.) for a population, rather than on an individual basis, can ensure access to treatment, reduce costs, and save lives.

Two articles from the special issue were posted on the Bloomberg School’s website in April, ahead of the journal’s publication, to inform the national conversation about creating a national PrEP program. The first, by Kenyon Farrow, chief executive of the advocacy group PrEP4All, explains the limitations of current patient assistance programs in reaching those most at risk of contracting HIV infection. The second, by longtime community HIV advocates, Jeremiah Johnson, PrEP Program Manager for PrEP4All; Asa Radix, clinical associate professor at New York University Grossman School of Medicine; Raniyah Copeland, founder of Equity & Impact Solutions; and Guillermo Chacon, President of the Latin American AIDS Commission, describes the unique challenges faced by transgender, mixed, black, and Latina communities that result in huge disparities in access to care.

Other articles in the special issue discuss ways to increase access to laboratory services for PrEP; international patterns of PrEP access; key implementation issues; the role of Medicaid; and the potential for partnerships with public health.

Key contributors to this special issue include Amy Killelea, Senior Associate in the Department of Health Policy and Management at the Bloomberg School, Jeremiah Johnson, PrEP Project Manager at PrEP4All, Chris Beyrer, now Director of Duke Global Health Institute, and Derek Dangerfield, now of George Washington University’s Milken Institute School of Public Health.

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