Geographic Access to Preexposure Prophylaxis and the Case for Telemedicine

We read the article “Geographic Access to Preexposure Prophylaxis Clinics Among Men Who Have Sex With Men in the United States” by Siegler et al.¹ The research used the national HIV preexposure prophylaxis (PrEP) provider directory PrEP Locator and data from the US Census Bureau on county-level estimates of men who have sex with men and identified several geographic areas in the United States with limited access to PrEP.

The study made a compelling case for how geographic barrier is a critical determinant in the accessibility of PrEP use and why the PrEP Locator is a resource that should be continually supported as a crucial component in HIV prevention strategies. We echo Siegler et al.’s call for novel interventions to improve PrEP access in resource-dispersed communities. In the area of telemedicine, there have been several state-driven efforts to leverage technology to improve PrEP delivery, including Iowa’s TelePrEP program² as well as the PrEP Assistance Program from the California Department of Public Health.³ Commercial entities such as Nurx and PlushCare⁴ also provide telemedicine for PrEP throughout the United States with few geographic limitations. The use of video messaging, telephone, or text messaging allows patients to consult with a PrEP-friendly provider privately and conveniently in their own home, an option that can increase access for those living in PrEP deserts. In addition, home-based collection test kits that allow patients to drop off samples or return specimens by mail may reduce the need for in-person laboratory visits. Similar models for electronic services in sexually transmitted infection testing and treatment have shown to be feasible and cost-effective,⁵ and early research on telemedicine for PrEP shows promise among young people, Black and Hispanic men who have sex with men, and those living in rural communities, with an encouraging level of initiation and six-month retention among users.⁶

The current bottleneck for the large-scale adaptability of telemedicine for PrEP is the financial costs associated with laboratory tests and physician appointments, which are often not covered by insurance and many government assistance programs.⁶ There should be a push for a centralized source of funding at the national level and a concrete investment in the prevention of HIV through increasing PrEP accessibility. Policy proposals that establish a federal grant toward that goal, such as the PrEP Assistance Program Act,⁷ offer a path to expand on the current effort in telemedicine and can maximize the effectiveness of PrEP by eliminating the effect of geography on access.