Medication to prevent HIV not reaching those who need it most: Engage study highlights barriers to accessing PrEP

Vancouver, British Columbia—In 2016, Health Canada approved a highly effective medication to prevent new HIV infections. Pre-Exposure Prophylaxis (PrEP) is a shown to reduce HIV acquisition for HIV-negative individuals by 86% in clinical trials. Yet, new HIV diagnoses in Canada have remained relatively stable over the past decade.

Findings from Engage—a study focused on the sexual health of gay, bisexual, and other men who have sex with men (GBM)—suggest more must be done to get PrEP to those who need it most.

Engage data from February 2017-March 2020 show PrEP use increased across all three study sites (Toronto, Montreal, and Vancouver), with a greatest increase in Vancouver. During this period, PrEP use increased from 14.2% to 39.3% in Montreal, from 21.4% to 31.4% in Toronto, and from 21.7% to 59.5% in Vancouver. However, 2020 data also indicate that only half (52.1%) of participants who met Canadian clinical recommendations for PrEP had taken PrEP in the last 6 months.

“We have lots of data to support PrEP as an effective HIV prevention tool,” says Dr. David Moore, public health physician and Co-Principal Investigator for the Engage study. “The focus now must be on reducing barriers to PrEP and ensuring that PrEP gets into the hands of individuals most at risk for HIV.”

One key barrier to PrEP uptake is the cost for individuals, which varies by province. In British Columbia, PrEP has been publicly funded with no additional costs to users since January 2018, a first in Canada. BC’s zero-cost program has also been strengthened by efforts to improve HIV awareness and testing, and cultural competency training for care providers working with GBM. To date, BC has reported over 5000 new PrEP users, of which, approximately 99% are GBM.

Outside of BC, coverage for PrEP varies, and co-payments often present barriers to PrEP uptake. In Quebec, for example, public insurance partly covers the cost of the medication, but most patients must pay roughly $95/month out-of-pocket to continue taking PrEP. In Ontario, those aged 25 and up may pay roughly $250/month without private insurance. Higher PrEP uptake in Vancouver suggests that full public coverage in other provinces—alongside awareness-raising and training for health care providers—would increase PrEP uptake and reduce new HIV infections.

There is also a role for the federal government to play in increasing funding for community-based organizations, which are often the first point of contact for GBM to discuss PrEP.

“When it comes to preventing HIV in Canada, we have the tools we need,” says Dr. Daniel Grace, Associate Professor at the University of Toronto, Dalla Lana School of Public Health. “We must remove structural barriers to HIV prevention and treatment to ensure equitable access for communities across Canada. This requires sustained commitments from the federal and provincial governments to support community organizations and make HIV prevention tools like PrEP free to everyone who may most benefit.”

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August 11th, 2022