A Plan to End the HIV Epidemic in Mecklenburg County

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In July 2012, the FDA approved Truvada as a prevention method for acquiring HIV. What is PrEP you may ask? Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy where HIV-negative individuals take anti-HIV medications before coming into contact with HIV to reduce their risk of becoming HIV positive.

The Truvada pill is a combination of two drugs that act against HIV. For PrEP, Truvada is taken once a day and it works to prevent HIV from establishing an infection inside the body. PrEP has been shown to reduce the risk of HIV infection through sex for men who have sex with men (MSM), transgender men and women, heterosexual men and women, as well as among people who inject drugs. It does not protect against other sexually transmitted infections (STI) or pregnancy. As a reminder, once an individual is HIV positive, currently there is no cure for HIV. Additionally, Descovy has now been approved for PrEP.

Charlotte/Mecklenburg County is experiencing among the highest rates of new HIV infections in the U.S. The Charlotte Metropolitan area is ranked among the worst 25 percent of metropolitan areas in the nation for new HIV infections, and some members of the population (e.g., young black men MSM (YBMSM)) experience higher rates of HIV acquisition than any other population. YBMSM, women of color, and persons who inject drugs (PWID) are among those with the highest rates of new infections, but the epidemic impacts virtually all groups within Mecklenburg County.

The reasons for the high rates of new HIV infections are mainly due to stigmatization, disparities in access to healthcare and insufficient and inefficient HIV prevention interventions. PrEP is vastly under-utilized in the southeast U.S. and Mecklenburg County.

With growing concern among community members, public health and healthcare providers, discussions began about the need for a more aggressive and comprehensive community-wide approach to decreasing new HIV infections in Mecklenburg County. In the Fall of 2017, encouraged by the renewed commitment of the Board of County Commissioners (BOCC), Mecklenburg County Public Health (MCPH), along with community members, HIV care providers, educators and members of the faith-based community, began a series of planning meetings to create plans for an aggressive, comprehensive, and effective community-level approach to decrease new HIV infections and to improve care for people living with HIV (PLWH). This collaboration led to the development of a plan to end the epidemic — the “Getting to Zero MeckCo.” plan from which the PrEP pilot was born. Its initial success led to its continuation and expansion under the name “the PrEP Initiative.”

The PrEP Initiative is intended to provide PrEP treatment to persons without healthcare coverage. Experienced medical clinics provide care and the PrEP Initiative funded by MCPH, covers the cost of labs, office visits and treatments for sexually transmitted diseases/infections STDs/STIs. Gilead Pharmaceuticals provides PrEP at no charge for individuals enrolled in the PrEP Initiative. The first client was enrolled in March 2018. To be eligible for inclusion in the PrEP Initiative, clients must be at risk for acquisition of HIV; their HIV status must be confirmed as negative at an initial screening visit; they must lack health insurance care coverage for PrEP; and they must be a Mecklenburg County resident. The client is also screened for sexually transmitted infections (e.g., chlamydia, gonorrhea, syphilis, hepatitis B & C). All women take a pregnancy test. If a patient is HIV negative and eligible for the program, they are enrolled in the Truvada or Descovy patient assistance program through Gilead Pharmaceuticals. Currently, there are seven clinical sites in Mecklenburg County participating in the PrEP Initiative. As of November 2019, almost 200 clients have been enrolled with zero new HIV cases among the clients receiving PrEP.

On Nov. 6, the North Carolina Association of County Commissioners presented Mecklenburg County with the 2019 Innovations Award for the PrEP Initiative. The PrEP Initiative reflects Mecklenburg County’s commitment to “use a truly exemplary innovative approach to end the HIV epidemic.” This approach has empowered the community to accept new ways to collaborate toward a common goal of reducing new HIV cases in Mecklenburg County.

For more information, contact one of the following partner providers: Amity Medical Group, Charlotte Community Health Center, The C.W. Williams Community Health Center, Inc., Eastowne Family Physicians, Quality Comprehensive Health Care Center and Rosedale Assistance & Opportunities (RAO). You may also visit mecknc.gov/prep.

Currently, North Carolina has over 35,000 citizens living with HIV, with an additional estimated 5,000 unaware of their status. There were 1,218 new HIV cases in 2018. In Mecklenburg County, there is an estimated 6,700 living with HIV and an additional 700 who are unaware of their diagnosis.

We now have pre-exposure prophylaxis (PrEP) to prevent HIV acquisition. We have post-exposure prophylaxis (PEP) for individuals possibly exposed to HIV within 72 hours and not on PrEP to prevent HIV acquisition. And we have treatment as prevention (TasP) which is part of the U=U initiative or Undetectable equals Untransmittable through intimate/sexual contact: this means for those individuals who are HIV positive and are serologically (by blood) undetectable, the risk of HIV transmission during intimate contact/sex is zero! With this triad of prevention and the participation of providers, partner agencies, Public health, and especially members of the community, HIV infections and the epidemic are not only controllable but stoppable.

J. Wesley Thompson, MHS, PA-C, AAHIVS, DFAAPA, is co-chair of the Mecklenburg’s Community HIV Planning Group and HIV medical director at Amity Medical Group.