October 21, 2016
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PrEP uptake remains low among at-risk women

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Although pre-exposure prophylaxis uptake is on the rise among populations at risk for HIV, uptake in women remains low, according to data from a retrospective analysis. Based on their findings, the researchers recommend interventions to increase PrEP uptake among women at risk for HIV infection.

“The impact of PrEP to decrease HIV incidence depends on its uptake among persons who are at substantial risk of HIV acquisition, and on adherence to daily dosing,” Hsiu Wu, PhD, of the division of HIV/AIDS prevention at the CDC, and colleagues wrote. “It is important to monitor PrEP uptake to increase our understanding of trends in its utilization, and to support the development of targeted implementation programs and policies to increase access for persons in populations most heavily affected by the HIV epidemic.”

Using the 2010 to 2014 MarketScan database, Wu and colleagues identified patients aged 16 years and older with commercial health insurance, identifying those prescribed disoproxil fumarate and emtricitabine for PrEP. They excluded patients who had any indication of prior HIV infection, along with those who may have used disoproxil fumarate and emtricitabine for post-exposure prophylaxis. The researchers used the data to form nationwide estimates of PrEP uptake.

PrEP uptake rose significantly during the study. An estimated 417 patients in the United States were prescribed PrEP in 2010, Wu and colleagues reported, followed by 506 in 2011, 765 in 2012, 1,947 in 2013 and 9,375 in 2014.

The mean age of patients using PrEP dropped from 44.4 years in 2010 to 37.8 in 2014, with the proportion of men rising from 82% to 97.5%. Each year more than 97% of PrEP users lived in a metropolitan statistical area, and more than 40% of users lived in the West in 2014.

The overall population of PrEP users with commercial health insurance increased from 3.3 persons per million in 2010 to 75.4 persons per million in 2014 (P < .001). In men, uptake was 151.2 per million in 2014 (P < .001). In women, uptake rose from 1.2 persons per million in 2010 to 3.7 persons per million in 2014 — still an upward trend, Wu and colleagues noted, but a much smaller increase than that reported in men (P < .001).

Researchers noted that the MarketScan analysis was limited to patients with commercial insurance and did not include risk behaviors such as injection drug use. However, “the MarketScan database and our analytic methodology provide the most feasible means to monitor PrEP uptake in the United States, and can be used to monitor progress in achieving goals of the recently updated National HIV/AIDS strategy,” Wu and colleagues wrote.

“The findings in our study highlight gaps in our national PrEP implementation efforts. It is especially important to make PrEP accessible to persons in populations with high rates of new HIV diagnoses such as young black MSM and at-risk women.” – by Andy Polhamus

 

Disclosure: The researchers report no relevant financial disclosures.