Hundreds of people are on a waiting list for the prep pill, a drug that protects against HIV infection. The delay is a result of the corona and monkeypox epidemics, which led to a war of burnout among infectious disease specialists.
At the Institute of Tropical Medicine (ITM) in Antwerp, the waiting time for a job interview is now four months. “The work is growing over our heads,” sighs HIV specialist Ludwig Apers. “This frustrates us, we are bored with the situation. Fortunately, some young colleagues have recently joined us, but getting to know them takes time.’ At the ITM, the largest HIV referral center in Flanders, 1,200 people receiving preventive antiretroviral drugs are followed up every year, and four hundred new applicants are added every year, whose suitability for treatment must be assessed.’
Since 2017, people at high risk of HIV infection have been able to receive a drug that protects them from infection. Most of them are men who have sex with varying numbers of men. The drug, known as prep for short, consists of a combination of two virus inhibitors. When taken daily, it provides almost 100% protection against HIV infection, even when condoms are not used during sex with HIV-positive partners.
The drug can only be prescribed with the approval of an infectious disease specialist affiliated with an HIV reference centre, of which there are only a dozen in our country. Every three months, users have to come back for a checkup, even for STDs, because the prep pill only protects against HIV and not against other sexually transmitted infections like syphilis, gonorrhea, or chlamydia. “Condom use among prep users is declining,” says Apers, “which translates into more STIs. This also increases the workload for doctors.’
High workload
Other HIV referral centers are also lagging behind. In the Sint-Pietersziekenhuis in Brussels, the waiting time for a job interview can be up to two months, says press spokeswoman Nathalie Schaar. UZ Leuven is also feeling the pressure, says spokeswoman Ann Lemaître, although the waiting time is only a few weeks, rather than a few months, because preparation candidates are seen at a general consultation and not a specialist preparation consultancy as in the other centers. ‘But this consultation is often overbooked, in part due to the high demand for prep drugs. This results in longer waiting times for those who want to come for a consultation for another reason.’
UZ Brussels is also feeling the pressure, says Sabine Allard, head of internal medicine, but not to the extent that waiting times are increasing dramatically. ‘We will make it, people can come in for a consultation within fourteen days. This is a normal waiting time.’
The cause of the increased waiting times is the corona epidemic. “Crown care ended up partly on the shoulders of infectious disease specialists who were already in charge of HIV care at HIV reference centres,” says Linos Vandekerckhove, head of the HIV reference center at the Ghent University Hospital. ‘Just when things calmed down a bit in that area, monkeypox arrived, followed by the monkeypox vaccination. Unlike the corona vaccination, which was instituted by the government, it was the responsibility of infectious disease specialists in reference centres. Due to the constant workload, several colleagues withdrew due to exhaustion.’
Due to the long waiting times, “waiting-listed infections” threaten, says Vandekerckhove: people who already have HIV when it’s finally their turn for a job interview. ‘Sometimes men have already had one or more high-risk contacts when they first come for a consultation. The waiting time should not exceed a few weeks. You don’t want to leave people to their own fate for months, or give them a choice: either safe sex or no sex.’
Transfer of care duties
There is currently no waiting list at the HIV referral center of the UZ Ghent. This is thanks to the collaboration the hospital has established with general practitioners in the region, says Vandekerckhove. They take some follow-up off the hands of hospitals, so infectious disease specialists have more time to process new claims. Discussions are also underway at the Sint-Pietersziekenhuis in Brussels about the possibility of dividing care among multiple care providers, spokeswoman Schaar says. “Like general practitioners, for example.”
Apers, of ITM, also sees potential in such collaboration, with infectious disease specialists in peripheral hospitals or with general practitioners. “We have to enter into discussions, even with the government and RIZIV, because according to current regulations only infectious disease specialists from a reference center can start preparing the drugs, otherwise there will be no reimbursement”.
On the other hand, says Apers, clients should not be victims of such decentralization and training of colleagues should be provided when care tasks are transferred. “We are dealing with a special population. These are not the average gay man in a steady relationship, but men with frequent and highly variable contacts, some of whom also use drugs during sex. This requires specialized socio-psychological care. Not all family doctors have experience with this.’
