The case for prescribing PrEP in community mental health settings

Andrew Sudler; Francine Cournos; Emily Arnold; Kimberly Koester; Nicholas S Riano; James Dilley; Albert Liu; Christina Mangurian

doi:10.1016/S2352-3018(20)30273-3

The case for prescribing PrEP in community mental health settings

Lancet HIV. 2021 Apr;8(4):e237-e244. doi: 10.1016/S2352-3018(20)30273-3. Epub 2021 Jan 22.

Authors

Andrew Sudler¹, Francine Cournos², Emily Arnold³, Kimberly Koester³, Nicholas S Riano⁴, James Dilley⁵, Albert Liu⁶, Christina Mangurian⁷

Affiliations

¹ Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
² Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA; Northeast/Caribbean AIDS Education and Training Center, New York, NY, USA.
³ Department of Medicine, University of California, San Francisco, CA, USA; Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA.
⁴ Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
⁵ Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Alliance Health Project, University of California, San Francisco, CA, USA.
⁶ Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Department of Public Health, San Francisco, CA, USA.
⁷ Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA; Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA. Electronic address: christina.mangurian@ucsf.edu.

PMID: 33493438
DOI: 10.1016/S2352-3018(20)30273-3

Abstract

Pre-exposure prophylaxis (PrEP) is a biomedical HIV prevention modality that is up to 99% effective in preventing HIV acquisition through sex if taken as directed. People with serious mental illness (eg, schizophrenia and bipolar disorder) are at high risk of acquiring HIV due to sexual behaviours, injection drug use, social factors, and structural discrimination that limits access to all types of preventive health services. We seek to show the importance of prioritising access to PrEP for people living with serious mental illness treated in community mental health settings. We describe barriers to prescribing PrEP, including provider attitudes and provider knowledge gaps, patient attitudes and knowledge, and systems issues. We also address the concerns that community mental health clinic administrators might have about taking on the responsibility of offering PrEP. In summary, despite the barriers to prescribing PrEP in these settings, we believe that there is a unique opportunity for community mental health settings to help address the HIV epidemic by facilitating the prescribing of PrEP to the at-risk populations they currently serve.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Community Mental Health Centers / organization & administration*
HIV Infections / epidemiology
HIV Infections / prevention & control*
Health Knowledge, Attitudes, Practice
Health Services Accessibility
Humans
Mental Disorders / epidemiology
Mental Disorders / psychology
Pre-Exposure Prophylaxis / organization & administration*
Preventive Health Services / organization & administration
Risk Factors

Grants and funding

R01 MH112420/MH/NIMH NIH HHS/United States