Study highlights “missed opportunities” to prevent HIV infections with PrEP

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In the three years following the U.S. Food and Drug Administration’s approval of a daily oral antiretroviral medicine to prevent HIV infection, records show that 885 South Carolina residents older than 13 were diagnosed with HIV. About two-thirds of them had visited health care facilities before their diagnoses — for a combined total of more than 4,000 visits.

Many of those visits represent missed opportunities to prevent their infection, as well as their risks of transmitting the virus to others, and of reliance on lifelong treatment and care, according to a study reported in January’s issue of Clinical Infectious Diseases.

The majority of those diagnosed did not have any health coverage. Just 18 percent had private health insurance. Possibly for that reason, the majority of the health care visits were paid to the emergency room. Across the visits to health providers, more than a quarter of the patients were diagnosed with sexually transmitted infections — a reason, according to Centers for Disease Control and Prevention guidelines, to consider prescribing PrEP — an antiretroviral medicine for pre-exposure prophylaxis against HIV.

National data showing that the number of people receiving PrEP climbed slowly during those years — from 72 in 2012 to 474 in 2016, however, indicates that nearly none of the South Carolina patients were provided with PrEP during any of their pre-diagnosis visits.

The patients who sought health services before their diagnoses represented other populations at heightened risks, and in the American south, greater incidence of HIV, noted in PrEP guidelines — with more women than men, more black patients than white, more younger than 30 than older.

While infectious disease specialists and primary care physicians have been the most targeted for training and education on PrEP provision the authors note, emergency room providers have expressed interest in learning more about the intervention.

The number of PrEP prescriptions in the American south, where most new diagnoses occur among African American men and women and young Hispanic men, remains “disturbingly low,” the authors note. Increased health care access and opportunities for HIV testing, as well as efforts to identify those who could benefit from PrEP, the authors write, will be critical to raising the numbers benefiting the proven preventative intervention.


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