title: Antiretroviral pre-exposure prophylaxis implementation in the United States: a work in progress.
abstract: BACKGROUND
  After the initial approval of the use of tenofovir disoproxil fumarate-emtricitabine (TDF/FTC) by the US Food and Drug Administration in 2012 for anti-HIV pre-exposure prophylaxis (PrEP), uptake was initially limited, but more recent community surveys and expert opinion suggest wider acceptance in some key populations.
  
  
  CONCLUSIONS
  Demonstration projects are underway to determine the best practices in the United States to identify at-risk individuals in primary care and sexually transmitted disease clinics who could benefit from PrEP. Studies of PrEP in combination with behavioural interventions are being evaluated. Studies to evaluate the use of PrEP by HIV-uninfected women in HIV-discordant couples interested in safe conception are also getting underway. The optimal deployment of PrEP as part of a comprehensive national HIV/AIDS strategy in the United States has been limited by lack of knowledge among some at-risk people and by some medical providers indicating that they do not feel sufficiently knowledgeable and comfortable in prescribing PrEP. Studies are underway to determine how to assist busy clinicians to determine which of their patients could benefit from PrEP. Although most federal health insurance programmes will cover most of the costs associated with PrEP, underinsured patients in states that have not enacted health reform face additional challenges in paying for PrEP medication and appropriate clinical monitoring.
  
  
  CONCLUSIONS
  PrEP implementation in the United States is a work in progress, with increasing awareness and uptake among some individuals in key populations.
authors.affiliation: The Fenway Institute, Fenway Health, Boston, MA, USA.|Beth Israel Deaconess Medical Center, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA; khmayer@gmail.com.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.affiliation: Stroger Hospital of Cook County/CORE Center, Chicago, IL, USA.
authors.forename: Sybil
authors.initials: S
authors.lastname: Hosek
authors.affiliation: San Francisco Department of Health, San Francisco, CA, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cohen
authors.affiliation: San Francisco Department of Health, San Francisco, CA, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Liu
authors.affiliation: AIDS Foundation of Chicago, Chicago, IL, USA.
authors.forename: Jim
authors.initials: J
authors.lastname: Pickett
authors.affiliation: AIDS Vaccine Advocacy Coalition, New York, NY, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Warren
authors.affiliation: The Fenway Institute, Fenway Health, Boston, MA, USA.|Beth Israel Deaconess Medical Center, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Krakower
authors.affiliation: Gladstone Institute, University of California, San Francisco, CA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Grant
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D065129:Pre-Exposure Prophylaxis; D014481:United States
chemical_list: D019380:Anti-HIV Agents
keywords: PrEP; pre-exposure prophylaxis; tenofovir-emtricitabine