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US PrEP care cascade analysis suggests that major, structural barriers need to be addressed for PrEP to have an impact
Roger Pebody, 2015-09-09 18:50:00
The uptake of PrEP in people who need it risks being limited due to low levels of awareness, gaps in health insurance, opaque bureaucratic procedures, under-usage of medical services, and limited awareness and skills in healthcare providers, according to an analysis published online ahead of print in Clinical Infectious Diseases. Also taking into account sub-optimal adherence among some PrEP users, the researchers conclude that just 15% of gay men in the American city of Atlanta who could benefit are likely to achieve protection from HIV with PrEP.
Colleen Kelley and colleagues at Emory University outline a ‘care cascade’ or ‘continuum of care’ for PrEP which identifies the key steps in the process of getting hold of PrEP and using it effectively. Analysis of the care cascade can help focus attention on where there are significant barriers to a person moving on to the next step.
This is similar to analyses of the antiretroviral treatment cascade – this highlights the proportion of people living with HIV who are diagnosed, linked to care, retained in care, on antiretroviral treatment and virally suppressed. Whereas some localities have problems in the early part of the cascade (e.g. people who remain undiagnosed), others have greater difficulties later on (e.g. keeping people in medical care). This helps identify where policy change is required.
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