According to this retrospective analysis of preexposure prophylaxis (PrEP) utilization rates in the United States, fewer than 20% of indicated users are taking the HIV preventive medication.
More than half of new annual HIV infections are occurring in the Southern region of the United States, despite just 30% of total users of preexposure prophylaxis living in those states, according to a new retrospective analysis of 2014-2018 PrEP state-level utilization rates in the United States.
“Since its FDA approval in 2012, uptake among individuals with indications for PrEP has been low in the United States,” the authors wrote.
Data for their investigation were provided by 2 sources: AidsVu.org (state-level numbers of individuals with PrEP prescriptions) and the CDC (state-level estimates of individuals with indications for PrEP). The CDC’s indications for PrEP are 3-fold:
There was a 1.18% (95% CI, 0.89%-1.46%) PrEP increase in a following year for every 5% of baseline PrEP usage in the previous year, the authors determined. This means that “disparities between high-uptake and low-uptake states increased between 2014 and 2018,” they wrote. Similar changes were not seen, however, for the 4 regions of the United States (Northeast, Midwest, West, and South; P = .29).
The Northeast, however, did have the highest PrEP uptake among the regions for the study period, at 16.6%, far outpacing the Midwest (9.2%), West (7.1%), and South (7.0%).
State-level analysis revealed these results:
The investigators explained that they expected higher rates of PrEP use in states late to the game in using the medication, because they would need to catch up to states already using PrEP. However, their findings demonstrate that “prior PrEP use predicted increased growth,” thereby contributing to the between-state disparities as shown by those findings.
Other reasons for the varying uptake levels include the use of social networks and peers to reduce stigma associated with PrEP usage and to increase knowledge of the preventive regimen, as well as health care provider and geographic variability of PrEP clinics.
“With disparities in PrEP uptake worsening, federal and state health policies must align with broader [Ending the HIV Epidemic] goals to ensure the plan’s success for all communities,” the authors concluded. “Further research on PrEP uptake should be conducted to target these policy proposals.”
To that end, they suggested identifying best practices from the states who adopted PrEP use early and had high uptake levels so they could be shared, and potentially adopted by, with other states. The authors also noted the success of HIV treatment drug-assistance programs, which target uninsured and underinsured individuals, and the potential of telehealth services in the space.
Powers SD, Rogawski McQuade ET, Killelea A, Horn T, McManus KA. Worsening disparities in state-level uptake of human immunodeficiency virus preexposure prophylaxis, 2014–2018. Open Forum Infect Dis. 2021;8(7):1-6. doi:10.1093/ofid/ofab293