HIV prevention guide lets patients compare PrEP options without risk screening

A new HIV prevention decision aid helped patients compare two forms of pre-exposure prophylaxis without first being asked to explain their personal risk, according to Rutgers University. Researchers said the approach could make conversations about PrEP less stigmatizing and help more people consider prevention medication.

The pilot study, published in PLOS Global Public Health, tested patient reactions to a two-page tool used in mock visits at three clinics. The guide compares a daily PrEP pill with a long-acting injectable PrEP option given every two months.

Rutgers said lead author Wendy Davis and senior author Deanna Kerrigan created the tool with collaborators at the University of North Carolina-Chapel Hill and community partners in Washington, D.C. Davis and Kerrigan developed it while at George Washington University and later joined the Rutgers School of Public Health.

Side-by-side PrEP choices

The decision aid presents the two prevention options in plain language, according to Rutgers. One section lays out how each product is used, how effective it is and what side effects patients may expect; another section asks patients to consider practical preferences, such as daily pill-taking compared with clinic visits for injections.

The researchers designed English- and Spanish-language versions of the guide. Rutgers said the aim was to give patients enough information to choose an option without requiring them to answer a risk assessment or describe sexual behavior before learning about PrEP.

That design responds to a gap in awareness, according to the study team. Rutgers said earlier interviews by the researchers found 80% of people who could benefit from PrEP had not heard of injectable PrEP, which the Food and Drug Administration approved in December 2021.

Use of the injectable option remains limited, the researchers said. Nationally, Rutgers reported, fewer than one in 200 PrEP prescriptions were for the injectable form, and in 2022 only 36% of the estimated 1.2 million Americans who could benefit from PrEP were using any form of it.

Patients reported less pressure to explain risk

Participants told the study team that the absence of a risk assessment made the tool feel different from standard prevention discussions, according to Rutgers. Because the guide did not ask them to account for why they wanted PrEP, participants said they did not feel they had to defend their interest in HIV prevention.

Some participants described the paper guide as a neutral presence that helped start the conversation and made the visit feel more balanced, Rutgers said. The researchers reported that this response stood out among people who may not commonly be seen as PrEP candidates, including older adults.

“We have a lot of options in HIV and other areas that we know work to protect and treat,” Davis said in a Rutgers statement. “A big challenge in public health now is how we make people aware of these options so they can use them to their benefit.”

Davis said the reaction showed the value of asking patients what information they want and how they prefer to receive it. “If you ask people what they want to know and how they want to receive it, and then you do that, they like it. It helps them decide,” she said.

Disparities remain a target

The researchers said the guide also addresses gaps in PrEP use among groups with disproportionate HIV diagnoses. Rutgers reported that women accounted for 8% of PrEP users in 2023 but 19% of new U.S. HIV diagnoses, while Black Americans represented 14% of PrEP users and 39% of new diagnoses.

The authors cautioned that the pilot had limits. Rutgers said the visits were simulated rather than actual appointments, participants’ answers may have been shaped by a desire to please researchers, and one clinic in the study may have had unusual experience with PrEP.

The study team said a larger trial in real clinical settings is needed. Rutgers said the tool is available through the open-access study and clinics may use it.

This story draws on original reporting from Medical Xpress.