New Insurance Coverage for HIV Therapy: What Nurses Need to Know

Joelle Y. Jean, FNP-C, BSN, RN
Updated September 21, 2023
Edited by
    The USPSTF recommends clinicians prescribe PrEP to high-risk patients who do not have HIV to prevent its spread. Learn more about how nurses can educate and deliver this treatment to patients who need it.
    Nurse discussing treatment options with patientCredit: Getty Images
    • The United States Preventive Services Task Force recommends clinicians prescribe antiretroviral therapy to high-risk sexually active adolescents and adults who do not have HIV, weighing at least 35 kilograms (77 pounds) to prevent its spread.
    • Nurse practitioners, nurses and nursing students can continue to educate and deliver this treatment more easily to patients who need it and serve as advocates by encouraging their practices and hospital administrators to do the same.

    On August 22, the United States Preventive Services Task Force (USPSTF) recommended clinicians prescribe antiretroviral therapy to high-risk sexually active adolescents and adults who do not have HIV, weighing at least 35kg (77 lbs) to prevent the spread of HIV.

    The grade A task force recommendation is a potential game-changer because it requires Medicare, Medicaid, and private insurers to cover the services at no cost to patients.

    Extensive research has shown the benefits of taking pre-exposure prophylaxis (PrEP) or antiretroviral medication. Clinical trials have also shown that the treatment has substantial preventive power against the spread of HIV.

    The new recommendation could help nurses, particularly nurse practitioners (NPs), deliver the PrEP treatment to higher-risk patients — and serve as advocates for colleagues to do the same.

    HIV and PrEP Therapy: An Overview

    The U.S. Food and Drug Administration (FDA) approved two PrEP treatments for at-risk adolescents and adults:

    1. Tenofovir alafenamide/emtricitabine (TAF/FTC) — taken orally
    2. Cabotegravir — taken by injection

    Individuals must have a negative HIV-1 test before starting PrEP. Patients taking TAF/FTC should obtain bloodwork before starting the medication and periodically throughout their treatment to prevent kidney damage. PrEP does not protect against other sexually transmitted infections and diseases.

    The two medications can be used in pregnant persons and those who are breastfeeding. Although not FDA-approved, CDC guidelines state that persons who inject drugs benefit from PrEP with any FDA-approved PrEP medication. These medications are excluded from receptive vaginal sex.

    Nurse practitioners, nurses and nursing students should identify individuals benefiting from PrEP. This can be difficult due to stigma, discrimination and the lack of trust some patients may have with the healthcare system. But, it is important for nurses, especially NPs, to ask their patients about their sexual and injection drug use history in a nonjudgemental manner.

    Educating the public about the benefits of PrEP can initiate conversations that otherwise may not be occurring. Lastly, clinicians should know policies and laws regarding prescribing PrEP to adolescent minors.

    Inside The USPSTF Recommendation

    According to USPSTF recommendations, the following persons should be considered for PrEP:

    1. Sexually active adults and adolescents who have engaged in anal or vaginal sex in the past six months and have any of the following:
      • A sexual partner who has HIV (especially if the partner has an unknown or detectable viral load).
      • A bacterial sexually transmitted infection (syphilis, gonorrhea, or chlamydia for men who have sex with men and transgender women; gonorrhea and syphilis for heterosexual women and men) in the past six months.
      • A history of inconsistent or no condom use with sex partner(s) whose HIV status is not known; assessing risk in conversation with the patient and considering factors such as number of partners, the specific sexual activities a person engages in, and whether their sex partner or partners are in a group with a higher prevalence of HIV (e.g., men who have sex with men or with men and women, transgender women, persons who inject drugs, and persons who engage in transactional sex).
    2. Persons who inject drugs and have a drug-injecting partner who has HIV or who shares injection equipment.
    3. Persons who have sex for money, including commercial sex workers or persons trafficked for sex work.

    Based on the recent report covering the USPSTF recommendation, an estimated 1.2 million persons live with HIV in the U.S.

    Since 1981, a reported 760,000 people have died of complications related to HIV. Adolescent and adult men make up 80% of new HIV diagnoses. Adolescent and adult women make up 18%.

    In 2020, men who have sex with men were most affected by HIV and accounted for 68% of new HIV diagnoses.

    In 2020, Black persons made up 42% of new HIV diagnoses, Hispanic/Latino persons made up 27%, and whites made up 26%.

    Studies show that Black women are four times less likely to start PrEP than white women. A limited number of study data have indicated that transgender women use PrEP less frequently than men who have sex with men.

    Now, more than ever, it is important for healthcare teams to inform all persons who are sexually active, persons who are disproportionately affected by HIV, or who inject drugs that getting HIV can be prevented.

    NPs, nurses, and nursing students are positioned to support patients and establish a relationship of trust to reduce stigmatization by providing evidence-based education on the use of PrEP, counseling on the use of condoms and safe sex, and reminders to take PrEP as directed.