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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.