Growth in Proportion and Disparities of HIV PrEP Use Among Key Populations Identified in the United States National Goals: Systematic Review and Meta-analysis of Published Surveys

Abstract

Background: Pre-exposure prophylaxis (PrEP) use among populations most vulnerable to HIV as identified in the national HIV prevention goals is not fully known. This systematic review assessed trends of lifetime self-reported PrEP use and disparities among key populations. Methods: We used the CDC HIV/AIDS Prevention Research Synthesis cumulative database of electronic and manual searches in MEDLINE, CINAHL, EMBASE, and PsycINFO from 2000 to 2019 to identify English-language primary studies reporting PrEP use. Two reviewers independently screened citations, extracted data, and assessed the risk of bias with the modified Newcastle–Ottawa Scale. We estimated pooled proportions and crude/adjusted odds ratio. Results: We identified 95 eligible studies including 95,854 US-based survey respondents. A few studies (6.3%) focused on persons who inject drugs. In 2015–2017, men who have sex with men (MSM) had highest proportion of individuals who used PrEP over their lifetime [13.9% (95% confidence interval: 8.8 to 21.1), k (number of surveys) = 49] followed by Hispanic/Latinos [11.5 (7.1 to 18.1), 12], transgender women [11.2 (5.8 to 20.6), 5], and blacks [9.9 (8.3 to 11.8), 18]. Odds of PrEP use increased by 34%/year [odds ratio = 1.34/year (95% confidence interval: 1.09 to 1.64)] and significantly increased over time among MSM [1.53/year (1.21–1.93)] and blacks [1.44 (1.13–1.83)]. People in the Southern United States [9.9 (4.7–19.7), 8] and youth [7.3 (4.7–11.2), 8] had lower rates and did not demonstrate growth [0.94 (0.29–3.18); 0.82 (0.43–1.55)]. Odds of reporting lifetime PrEP use was twice [2.07 (1.27–3.38)] as great among MSM than non-MSM. Conclusions: Proportions of PrEP use in published surveys have been growing, but remain low for people in the Southern United States and youth, and understudied in persons who inject drugs. Limitations include few studies in certain years, whereas strengths include a large number of respondents. Culturally tailored approaches targeting vulnerable populations are essential in increasing PrEP use to reduce disparities in HIV acquisition.

HIV Preexposure Prophylaxis Awareness and Referral to Providers Among Hispanic/Latino Persons — United States, 2019

“…PrEP awareness and referral were higher among Hispanic MSM and transgender persons than among those in other population groups. This finding is consistent with other studies that have documented higher PrEP coverage among MSM and transgender persons ( 3 , 5 ). Given that HIV incidence and prevalence are substantially higher among MSM and transgender persons ( 1 , 6 ), efforts to further increase PrEP awareness and referral among these populations are important to reach persons who might benefit from a PrEP prescription.…”

A retrospective study of HIV pre‐exposure prophylaxis counselling among non‐Hispanic Black youth diagnosed with bacterial sexually transmitted infections in the United States, 2014–2019

“…Although we were unable to directly compare rates of PrEP counselling to other groups, the very low rates of PrEP counselling and prescription among this cohort are consistent with other studies that have shown inequitable PrEP care continuum outcomes among Black individuals [ 7 , 16 , 61 , 63 , 64 ] and highlight the urgent need to ensure equitable PrEP access among this priority population or risk potentiating existing HIV disparities rather than alleviating them. Further investigation is warranted to identify and remove barriers to provider‐, clinic‐ and system‐level PrEP implementation.…”

“…Per CDC guidelines, a bacterial STI diagnosis in the previous 6 months was an indication due to sexual risk behaviour [ 6 , 9 ]. Although youth account for a disproportionate number of incident HIV and bacterial STI infections, PrEP use among U.S. youth remains limited [ 7 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

A Scoping Review Investigating Relationships between Depression, Anxiety, and the PrEP Care Continuum in the United States

“…Despite a strong safety profile and high efficacy for preventing HIV, uptake of PrEP has been slow and uneven in the US [ 14 , 15 ]. In addition, among those who do initiate PrEP, significant racial and ethnic disparities exist, with African American and Hispanic individuals being much less likely to use PrEP than White individuals, despite their higher HIV risk [ 16 ].…”