Roll-out / Scale-Up of Truvada PrEP presented in Lesson 10 vs the US experience

I found lesson 10 presented a good and comprehensive but somewhat idealized picture of how product roll-out and scale up would occur. I think it was very useful in terms of understanding how this would occur in resource limited settings and/or more resourced countries where there is universal or strong public health promotion. On the other hand, I felt it omitted some significant complicating realities of Truvada as PrEP roll-out in the U.S.

Food for thought:

How did the fact that Truvada was an already available and approved  drug for HIV treatment of the U.S. change the realities, challenges, and successes for rolling out and scaling up this intervention in the U.S?

It was legal for physicians to prescribe Truvada for prevention before FDA approval as an evidence-based “off-label” use in the U.S. far before FDA approval, and this was ethically supported as an evidence-based practice once trial results were announced. How did this positively or negatively impact roll-out and scale-up of PrEP in the U.S?

Once Truvada was approved for prevention in the U.S., how did the fact that healthcare in the U.S. is  largely a profit-making, capitalism-based construct and not equally accessible to all of its citizens, impact roll-out and scale up?