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An HIV Game-Changer: Expanding access to PrEP

Since the early, unpredictable days of the HIV/AIDS pandemic, treatment, knowledge, and attitudes towards the virus and those suffering from it have come a long way. When taken regularly, modern medicines can effectively reduce an HIV infection to undetectable levels, and recent studies have shown that individuals who maintain an undetectable viral load cannot infect others.

Effective management of HIV is not all that has changed. The development of pre-exposure prophylaxis (PrEP) has been described as a game-changer. PrEP is a medication that, when taken daily, can prevent HIV infection if an exposure occurs. In fact, a 2020 report showed that new HIV infections among high-risk groups were at a 20-year low, due in part to the increasing use of PrEP.

Dr. Kevin Woodward specializes in the management of infectious diseases

Dr. Kevin Woodward is an infectious diseases physician and researcher at St. Joe’s, specializing in the prevention and treatment of sexually transmitted infections, including HIV. Since 2013, Dr. Woodward has been prescribing PrEP for HIV prevention at the Hamilton PrEP Clinic, which accepts physician- and self-referrals for at-risk individuals.

Access to PrEP can be lifesaving, but unfortunately Ontario lacks the clinical capacity it needs to prescribe it across the entire province. Many patients in Ontario can’t access PrEP outside of large cities like Hamilton, Toronto, and Ottawa. To expand access to PrEP and ultimately reduce new HIV infections in Ontario, Dr. Woodward is focusing on three key areas: clinical implementation, research, and education.

Locally, Dr. Woodward has been working with clinicians to expand referral opportunities. This includes intercepting patients during hospital stays related to intravenous drug use, since shared needles can be a vector for HIV transmission. His clinic’s efforts have also inspired change at Hamilton Public Health, where PrEP referrals are now offered to at-risk patients.

Extensive research has been conducted on the efficacy and safety of PrEP. Dr. Woodward and his colleagues are now focusing their research on implementation and logistics, prioritizing studies on how to best train primary care physicians to prescribe and manage PrEP.

Dr. Kevin Woodward

“Our current challenge is to get more primary care physicians comfortable in prescribing PrEP and managing the follow-up. Physicians need to be prepared to schedule regular testing for their patients every 3 months as well as develop a level of comfort in diagnosing and treating STIs.”

Dr. Woodward discusses the benefits of PrEP at his Hamilton clinic

Health Canada’s PrEP guidelines recommend testing every 3 months for HIV and other sexually transmitted infections, as well as testing for kidney function. The most widely available iteration of PrEP (due to its availability as a generic drug) can have a minor effect on the kidneys. Fortunately, the latest form PrEP, sold as Descovy®, appears to have fewer kidney-related side effects and has just been approved by Health Canada. Regular blood tests can help physicians track any changes in kidney function.

To further drive change and increase clinicians’ knowledge of PrEP, Dr. Woodward has been travelling across Ontario to various community health centres, offering PrEP education talks focused on primary care providers. Part of the larger strategy also includes understanding missed opportunities for discussing PrEP with patients. For example, at-risk patients who have been newly diagnosed with a bacterial STI by their primary care physician would benefit by learning how PrEP can help reduce their risk of HIV infection. With the challenges of COVID-19, these educational sessions have moved online for 2020.

Collectively, these efforts aim to eliminate the inequities that are preventing many Ontarians from accessing this powerful tool in the fight against the HIV/AIDS pandemic.

“Where you live shouldn’t negatively affect the health care services you receive,” says Dr. Woodward. “Right now, expanding the use of PrEP is the most effective strategy we have to prevent new HIV infections.”