HIV Pre- and Post-Exposure Prophylaxis Dispensation

In Missouri, over 12,000 people live with HIV, and over 500 new HIV infections are diagnosed each year. Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medications are highly effective methods of blocking HIV infection in individuals who are at high risk of exposure, or who have been recently exposed. Currently in Missouri, clinicians may prescribe and dispense PrEP and PEP as long as the individual seeking the medication meets eligibility criteria set by the provider, such as injection drug use or sexual contact with an HIV-positive partner. In addition, Washington University in St. Louis currently collaborates with the Missouri Department of Health and Senior Services to operate pharmacy-based PrEP care, the only program of its type in the state. SB 79 would authorize licensed pharmacists to independently dispense a thirty-day supply of PrEP and a complete course of PEP. In order to dispense these medications, pharmacists must first complete a training program. Dispensation of these medications is also subject to several restrictions: those seeking PrEP must test negative for HIV, receive counseling related to the treatment, and notify their health care provider of prophylaxis treatment. Similar laws are currently in effect in Colorado, Oregon, and California.

Highlights

• PrEP and PEP are highly effective medications (up to 90% effective with proper adherence) for preventing HIV infection.
• There is no evidence of severe negative health effects due to PrEP or PEP.
• PEP has only been demonstrated to be effective when administered within 72 hours of a potential exposure to HIV, so rapid access to PEP is necessary for it to be a useful treatment.
• Black and Hispanic Missourians are disproportionately affected by HIV but are less likely to receive therapeutics.

Limitations

• Due to the ethics of withholding potentially life-saving medication and the difficulty of recruiting large populations, there are no randomized controlled trials demonstrating the efficacy of PEP. Instead, researchers rely on results from animal models, cases involving pregnant women, and studies of healthcare workplace exposures to HIV.
• Similar legislation has been in effect in CO, OR, and CA for under two years, so it is difficult to conclusively assess the effect this policy has had elsewhere.