GeSIDA recommends broadening PrEP access criteria to improve access

On the occasion of the fifth anniversary of the inclusion of PrEP (pre-exposure prophylaxis for HIV) in the NHS core portfolio – which occurred on 30 September – and given the good results this has brought to the prevention strategy –of which over the years more than 24,000 people have used according to the Department for the Control of HIV, STIs, Viral Hepatitis and Tuberculosis of the Ministry of Health – GeSIDA (Group for the Study of AIDS of the Spanish Society of Infectious Diseases and Clinical Microbiology) invites competent administrations to consider expand access criteria and also provide this preventive treatment to more people, such as those diagnosed with hepatitis C. or people who do not meet any of these criteria at the time of risk assessment, but who demonstrate a change in their situation in the near future, for example, stopping systematic use of condoms.

To facilitate access to PrEP, which is based on medicines dispensed in the hospital, GeSIDA also offers moving this treatment away from hospital pharmacies and toward the medical devices that serve these users: STI clinics. (sexually transmitted infections) or other community centers such as primary health care centers or community centers.

PrEP should be prescribed and monitored by a physician experienced in treating HIV and other STIs, and trained in how to care for sexual and gender diversity and chemsex.

In addition, the role of specialized nursing is fundamental. For this proposal to be possible, hospital and community units must be provided with sufficient staff and resources to adequately meet demand and follow-up of users, and reduce waiting lists for access to PrEP.

This study group also emphasizes the importance of appropriate monitoring of people who should receive PrEP, which should include obtaining a complete clinical history, including toxic habits and sexual behavior; pre-prescription analytical assessment – to exclude pre-existing HIV infection, assess the serological status of hepatitis A, B and C viruses, or assess renal function; conducting full screening for other STIs; emphasize the importance of proper adherence to the therapeutic regimen; initiate vaccination against hepatitis A and B and HPV when necessary; assess drug tolerability and possible side effects; and periodically review indications for continued PrEP.

PrEP and other STIs

In contrast to what has happened with HIV, the past two decades have seen an increase in the number of STI diagnoses in our community, especially gonorrhea, chlamydia and syphilis, and more recently hepatitis C among men who have sex with other men (MSM). For this reason, GeSIDA insists that “PrEP is part of a program that also includes a combination of interventions such as condom promotion, sexuality education, substance use assessment, early detection and treatment of STIs, and updating recommended vaccines.“, emphasizes Dr. Rosario Palacios, president of this research group.

Today, it is still unclear whether the use of PrEP contributes to the increase in the incidence of STIs. For example, a study conducted in different centers providing PrEP in Spain did not find a significant increase in the incidence of some STIs, such as gonorrhea, chlamydia and syphilis.

Although various studies have disagreed about the possible increased incidence of STIs in PrEP users, systematic STI screening allows for timely detection and treatment of other STIs, which may reduce their transmission. That’s why GeSIDA recommends being tested for syphilis, chlamydia and gonorrhea every three to six months, and being tested for hepatitis C every 6 to 12 months, depending on each person’s risk.