Pre-exposure prophylaxis (PrEP) has been crucial in HIV prevention and treatment, yet gaps remain in implementation, particularly among populations with limited access to HIV specialists. In many health systems, including parts of Europe, PrEP is predominantly prescribed by infectious diseases or HIV subspecialists rather than primary care physicians, according to Jürgen Rockstroh, MD, Professor of Medicine at the University Hospital in Bonn who specializes in HIV and viral hepatitis. This subspecialty-centric model can create barriers for at-risk individuals who live outside major urban centers, face long wait times, or are reluctant to seek care in specialized clinics because of stigma or logistical constraints. As a result, a substantial proportion of individuals who would benefit from PrEP remain unprotected, Rockstroh told Patient Care Online.
Current oral PrEP options, often based on generic tenofovir disoproxil fumarate/emtricitabine, provide highly effective protection when taken consistently and are relatively inexpensive in some settings. However, daily adherence to oral PrEP therapies poses a challenge for many vulnerable populations, including individuals experiencing stigma, unstable housing, or other social determinants of health that complicate routine medication use. Long-acting injectable and extended-interval oral agents under development or already available offer the promise of less frequent dosing—ranging from monthly tablets to injections every 2 or 6 months—but these advances must be weighed against significantly higher acquisition costs and the added logistical burden of injection visits.
For primary care physicians, integrating HIV prevention and treatment into routine practice represents a major opportunity to close gaps in care. Simplified PrEP pathways, clear reimbursement policies, and alignment with affordable options will be critical to enabling broader uptake in primary care. At the same time, newer long-acting agents may be particularly valuable for patients who are unable to adhere to daily oral regimens, provided they are accessible and cost-effective within a given health system. Rockstroh highlights the strong momentum in long-acting prevention and treatment strategies and describes the palpable optimism at recent scientific meetings regarding their potential to change HIV prevention, particularly for women in high-burden settings and other populations not well served by oral PrEP.
