A lack of specialists is slowing the implementation of a HIV pre-exposure pill, which health researchers say could be a gamechanger for New Zealand's HIV epidemic.
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The findings of research, funded by the New Zealand AIDS Foundation (NZAF), were published in the New Zealand Medical Journal today.
New Zealand became one of the first countries in the world to publicly fund PrEP in March 2018, for men who have sex with men, or transgender people, who meet the eligibility criteria.
This criteria included those who engage in sexual activity without condoms being consistently used, or people who had a regular sexual partner who was HIV positive.
According to Pharmac, 700-900 people were taking the drug, but this only makes up a small proportion of the approximately 5800 who were eligible.
Research author Peter Saxton from the University of Auckland said one of the most critical concerns was the prescribing bottleneck.
"At the moment PrEP can only be approved from one of around 45 HIV specialists in the country and repeat prescriptions can be given by nurse practitioners and GPs who have gone through an accredited course.
"It just means at the moment the range of people who can prescribe PrEP is really limited," he said.
Dr Saxton said if all those eligible took the pill, this would equate to around 29,000 clinic appointments every year, half of which would be in Auckland.
"That really is a challenge to the health system, sexual health clinics themselves clearly can't cope with that volume," he said.
He wanted to encourage the GP community to talk about how to increase access to prEP, and look to innovate.
NZAF executive director Jason Myers said overseas modelling showed to reach its maximum effectiveness, the initial rollout of PrEP needed to be as rapid and equitable as possible.
"When we have low levels of knowledge in pockets of primary care and pharmacies who are not willing to stock the drug, these are all things that place rapid scale up at risk."
He said collaboration was needed to address the challenges, so New Zealand can reap the most benefit from the drug.
The paper said together, condoms, increased HIV testing, treating HIV, and PrEP can enable New Zealand to regain control of, and work towards, HIV elimination.
Behaviour monitoring needed following implementation
A recent study in Melbourne and Sydney, showed the use of PrEP led to behavioural changes in the gay and bisexual communities.
Author, University of New South Wales' Professor Martin Holt said over a three year period the number of those taking the pill rose to 24 percent, but another form of protection declined.
"As PrEP use became more commonly used, consistent condom use by other gay and bisexual men fell," he said.
However, Professor Holt said the overall the rapid uptake of PrEP had a positive impact.
He added although PrEP doesn't prevent against STIs, those taking prep are the most tested for infections, due to regular visits with their GP.
Professor Holt added it is important to keep up regular behaviour monitoring and surveys of what's happening within the gay and bisexual communities, following implementation.
He said he was intrigued to see what happens in New Zealand, as our population size means we have the potential to be a world leader in HIV elimination.
