BU study: PrEP to reduce HIV incidence not available in one in three New England colleges and universities

(Boston)—Young gay, bisexual, and other men who have sex with men (MSM), accounted for 80% of new HIV infections among youth ages 13–24 in 2018 and represents a priority population for HIV prevention. HIV pre-exposure prophylaxis (PrEP) with daily oral tenofovir/emtricitabine reduces HIV incidence by more than 90% in MSM, yet remains underutilized. For many young MSM, the time-period of highest HIV risk occurs during their college years. While college student health services (SHS) are uniquely positioned to provide HIV prevention services, little is known about the availability of PrEP in those settings.

A new survey of medical directors of New England colleges and universities SHS by researchers at Boston University Chobanian & Avedisian School of Medicine has found that more than one-third of those institutions did not offer PrEP. The study reveals a substantial gap in PrEP access and a lost opportunity to reach more students during a critical time of increased HIV risk behaviors.

“The low rates of PrEP coverage within the college-age group represents an untapped opportunity to deliver PrEP to college-enrolled young MSM and other students not currently reached by traditional outpatient services,” said corresponding author Samantha Rawlins-Pilgrim, MD, MSc, voluntary assistant professor of medicine at the School.

In an effort to determine the availability of PrEP in SHS, the researchers conducted an electronic survey of medical directors at New England colleges and universities. Of 143 institutions surveyed, 36% of institutions did not offer PrEP. Institutions that did were more likely to be four-year private schools with higher endowments.

According to the researchers, PrEP provision was strongly tied to institutional resources and medical directors noted the need for additional support staff for PrEP implementation. Among institutions not offering PrEP, the most commonly cited barriers were lack of insurance coverage, clinical monitoring requirements and staffing/time constraints. Access to on-site support staff, institutional willingness for new protocols, clinician peer champions and PrEP guidelines and protocols were identified as potential facilitators of implementation.

“SHS, particularly those at two-year and public institutions, will likely require funding to develop PrEP infrastructure. Expansion of PrEP coverage by student insurance plans as well as access to navigation for enrollment in drug assistance programs could help make PrEP accessible for more students,” said Rawlins-Pilgrim, who also is an attending physician at Boston Medical Center.

Funding for this study was provided by a HRSA grant for the preventive medicine residency through BU (HRSA D33HP29243) and CTSI funding (1UL1TR00143) through BU.

S Rawlins-Pilgrimhas received an honorarium from the Boston University Chobanian and Avedesian School of Medicine Continuing Medical Education office fora program funded via an unrestricted educational grant from Gilead Sciences, Inc. A Wheelock receives salary support from NIH training grant T32HL125232- 07. CG Streed Jr receives salary support from: Providence/Boston Center for AIDS Research Interest Group (P30AI042853- 23), Boston University School of Medicine Department of Medicine Career Investment Award American Heart Association career development grant (AHA20CDA35320148), National Heart, Lung, and Blood Institute career development grant (NHLBI 1K01HL151902-01A1), Doris Duke Charitable Foundation (Grant #2022061). DS Krakower has consulted with Fenway Health for research funded by Gilead Sciences and Merck. He receives salary support from the Harvard University Center for AIDS Research (CFAR), an NIH funded program (P30AI060354). He has also received honoraria from DKB Med and Virology Education for developing medical education content and royalties from Up To Date Inc for authoring medical education content. JL Taylor receives salary support from a grant from the Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences, Office of HIV/AIDS for HIV/HCV/STI/TB Prevention, Linkage, and Retention in Care[INTF4944MM3181926007]. She has received an honorarium for an eHIV Review on PrEP in PWID from Johns Hopkins School of Medicine, a program funded via unrestricted educational grants from Gilead Sciences, Inc. and ViiV Healthcare. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of [country name] the United States of America and received approval from the [Institutional Review Board of university name] received an exemption from the Institutional Review Board of the Boston University Medical Campus and Boston Medical Center.