Dr Kevin Astle Discusses Therapies in HIV PrEP Pipeline and Trends in Access, Adherence

Kevin N. Astle, PharmD, assistant professor at University of South Florida Taneja College of Pharmacy, expands on HIV pre-exposure prophylaxis (PrEP) therapies in the pipeline discussed at the Academy of Managed Care Pharmacy Nexus fall 2022 meeting.

As new HIV pre-exposure prophylaxis (PrEP) therapies gain FDA approval, there may still be concerns surrounding access and payment reimbursement. According to Kevin N. Astle, PharmD, assistant professor at University of South Florida Taneja College of Pharmacy, if these barriers are alleviated, adherence to these therapies should be a minimal concern.


What HIV PrEP therapies are currently in the pipeline?

In the pipeline, we have a new exciting option coming up soon: lenacapavir injection, it's a 6-month injection. We're seeing the benefits that we have with cabotegravir of every 2 months. Now patients can come into clinic just twice a year to really improve access and try to reduce as many of those barriers as we can.

Other options right now: there's a dapivirine intravaginal ring for cisgender women who are able to use this to discreetly reduce their risk for HIV infection. Those are kind of the key ones that are coming through right now, but there's many other options that are tablets, implantable devices, and then even getting further to antibodies and vaccine-type interventions.

If these therapies receive FDA approval, what trends do you anticipate in terms of access and adherence?

I think we're going to see some of the same struggles with access as far as providers administering the new medications in their clinic, we're going to see payment reimbursement concerns, but if those are alleviated then adherence should be a very minimal concern. Like I said, it's going to be once every 6 months injection, so patients can pretty easily get to clinic within that window. I think we'll see communities doing some innovative techniques to get patients their medications as well.

A community partner that I've worked with has a mobile testing unit, which can do HIV and STI [sexually transmitted infection] testing on the go. So, going into the communities that are most at-risk and doing testing on the spot, and then with negative HIV tests, being able to provide PrEP right then and there. If we're able to do injections through mobile testing units, we can really reach out to some of these communities that are facing those social determinants of health.

What is a general takeaway from your session addressing disparities in HIV PrEP access and uptake?

We have these products that have high efficacy, we see the studies that they're almost 100% effective, and now we just really need to target these communities. The same communities that are hardest hit by the HIV epidemic—Black, gay men and transgender women—are also our lowest uptakes for PrEP. So really, what can we do as a system to increase uptake and access to medications?

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