Pre-exposure Prophylaxis: Clinical Considerations for Overcoming Barriers to Uptake and Persistence

Pre-exposure prophylaxis (PrEP) is the administration of antiretroviral medications before HIV exposure to prevent HIV infection. PrEP or biomedical prevention is an essential part of the ending the HIV epidemic strategy. Currently, there are 4 guideline-approved dosing approaches to PrEP, which include 2 oral formulations and 1 long-acting injectable. Unfortunately, most individuals who would benefit from PrEP do not receive a prescription, and even fewer initiate and continue PrEP. Barriers to PrEP uptake and persistence are complex and extend along a socio-ecologic framework from individual through structural. In this article, we highlight the barriers to PrEP care among priority populations, discuss evidence-based solutions, and offer multilevel considerations for clinicians, researchers, and community members to increase access, uptake, and persistence in PrEP care for all.