The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis–to-need ratio in the fourth quarter of 2017, United States

Siegler, Aaron J; Mouhanna, Farah; Mera, Robertino; Weiss, Kevin M; Pembleton, Elizabeth; Guest, Jodie L; Jones, Jeb; Castel, Amanda D.; Yeung, Howa; Kramer, Michael R.; McCallister, Scott; Sullivan, Patrick S.

doi:10.1016/j.annepidem.2018.06.005

Cited by 319 publications

(236 citation statements)

References 27 publications

(24 reference statements)

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“…Among our study population, the 18 to 24 age group had higher rates of non‐persistence on medication for all time periods. This finding is consistent with data on national PrEP prevalence trends , and with current PrEP prevalence data that find comparatively low prevalence of PrEP use for these groups . Despite this, 18‐ to 24‐year‐olds are a key group to target for retention on PrEP because they are among the groups at highest risk for transmission .…”

Section: Discussionsupporting

confidence: 89%

Persistence on HIV preexposure prophylaxis medication over a 2‐year period among a national sample of 7148 PrEP users, United States, 2015 to 2017

et al. 2019

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Introduction Persistence on preexposure prophylaxis for HIV prevention (PrEP) medication has rarely been reported for periods greater than one year, or in real‐world settings. This study used pharmacy fill records for PrEP users from a national chain pharmacy to describe persistence on PrEP medication over a two‐year period, and to explore correlates with PrEP medication persistence in a real‐world setting. Methods We analysed de‐identified pharmacy fill records of 7148 eligible individuals who initiated PrEP in 2015 at a national chain pharmacy. A standard algorithm was employed to identify TDF‐FTC use for PrEP indication. We considered three time periods for persistence, defined as maintaining refills in PrEP care: year 1 (zero to twelve months), year 2 (thirteen to twenty‐four months) and initiation to year 2 (zero to twenty‐four months). Individuals with 16 or more days of TDF‐FTC PrEP dispensed in a 1‐month period for at least three‐quarters of a given time period (e.g. nine of twelve months or eighteen of twenty‐four months) were classified as persistent on PrEP medication for the period. Results Persistence was 56% in year 1, 63% in year 2 and 41% from initiation to year 2. Individuals aged 18 to 24 had the lowest persistence, with 29% from initiation to year 2. Men had higher persistence than women, with 42% compared to 20% persistent from initiation to year 2. Individuals with commercial insurance and individuals who utilized a community‐based specialty pharmacy from the national chain also had higher persistence. Male gender, age >18 to 24 years, average monthly copay of $20 or less, commercial insurance, and utilization of a community‐based specialty pharmacy were positively associated in adjusted models with persistence in year 1 and from initiation to year 2; the same correlates, with the exception of utilization of a community‐based specialty pharmacy, were associated with higher persistence in year 2. Conclusions We found substantial non‐persistence on PrEP medication in both year 1 and year 2. Across the entire 2‐year period, only two out of every five users persisted on PrEP. Demographic, financial and pharmacy factors were associated with persistence. Further research is needed to explore how social, structural or individual factors may undermine or enhance persistence on PrEP, and to develop interventions to assist persistence on PrEP.

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Section: Discussionsupporting

confidence: 89%

Persistence on HIV preexposure prophylaxis medication over a 2‐year period among a national sample of 7148 PrEP users, United States, 2015 to 2017

et al. 2019

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“…Thus, although Black and white MSM have similar levels of self‐reported PrEP usage, based on the higher risk of HIV acquisition for Black MSM, the levels of use among Black MSM might still be relatively inadequate. This concept has been formalized as the PrEP to need ratio, which expresses PrEP use in terms of the population‐specific magnitude of new HIV diagnoses .…”

Section: Discussionmentioning

confidence: 99%

National trends in HIV pre‐exposure prophylaxis awareness, willingness and use among United States men who have sex with men recruited online, 2013 through 2017

et al. 2020

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Introduction Pre‐exposure prophylaxis (PrEP) is a key HIV prevention technology, and is a pillar of a comprehensive HIV prevention approach for men who have sex with men (MSM). Because there have been no national data to characterize trends in the PrEP continuum in the United States, overall and for key demographic groups of MSM, we aimed to describe the extent to which PrEP awareness, willingness and use changed over time, overall and for specific groups of MSM critical for HIV prevention (e.g. Black and Hispanic MSM, younger MSM, MSM in rural areas and MSM without health coverage). Methods The American Men's Internet Survey (AMIS) is an annual survey of US MSM conducted in the United States among MSM aged ≥15 years since 2013. We analysed data on trends in elements of the PrEP continuum (awareness, willingness and use of PrEP) in a sample of 37,476 HIV‐negative/unknown status MSM from December 2013 through November 2017. We evaluated trends in continuum steps overall and among demographic subgroups using Poisson models with Generalized Estimating Equations. For 2017 data, we used logistic regression to compare the prevalence of PrEP use among demographic groups. Results Overall, 51.4% (n = 19,244) of AMIS respondents were PrEP‐eligible across study years. Between 2013 and 2017, PrEP awareness increased from 47.4% to 80.6% willingness to use PrEP increased from 43.9% to 59.5% and PrEP use in the past 12 months increased from 1.7% to 19.9%. In 2017, use of PrEP was lower for men who were younger, lived outside of urban areas, and lacked health insurance; PrEP use was not different among Black, Hispanic and white MSM. Conclusions Our data show progress in use of PrEP among US MSM, but also reveal mismatches between PrEP use and epidemic need. We call for additional support of PrEP initiation, especially among young, non‐urban and uninsured MSM. Black and Hispanic MSM report levels of PrEP use no different from white MSM, but given higher HIV incidence for Black and Hispanic MSM, parity in use is not sufficient for epidemic control or health equity.

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“…In contraception, a common metric is unmet need, which is determined by the prevalence of several factors, such as pregnancy risk and fertility intention and may be more relevant to developing a PrEP denominator. However, calculating unmet need is a difficult undertaking and there may be more accessible metrics for PrEP, such as the PrEP‐to‐need ratio . It is important to note that there is no threshold or goal for PrEP‐to‐need ratios, but it has been used to compare PrEP uptake between key populations .…”

Section: Discussionmentioning

confidence: 99%

Global implementation of PrEP for HIV prevention: setting expectations for impact

Pyra

Haberer

Hasen³

et al. 2019

J Intern AIDS Soc

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Introduction Questions remain whether HIV pre‐exposure prophylaxis (PrEP) can be translated into a successful public health intervention, leading to a decrease in population‐level HIV incidence. We use examples from HIV treatment and contraceptives to discuss expectations for PrEP uptake, adherence, and persistence and their combined impact on the epidemic. Discussion Targets for PrEP uptake must be based on the local HIV epidemic and will depend on appropriate estimates of the key populations at risk for HIV. However, there is evidence that targets, once established, can successfully be met and that uptake may increase with awareness. Messaging around adherence should include that daily adherence is the goal (except for those MSM for whom event‐driven dosing is a good fit), but perfect adherence should not be a barrier. Ideally, clients persist on PrEP for as long as they are at risk for HIV. While PrEP will be most effective when coverage is focused on high‐risk populations, normalizing rather than stigmatizing PrEP will be highly beneficial. Conclusions While many challenges to PrEP implementation exist, we focused on the three key steps of uptake, adherence and persistence as measurable processes that can lead to improved coverage and decreased HIV incidence.

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The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis–to-need ratio in the fourth quarter of 2017, United States

Cited by 319 publications

References 27 publications

Persistence on HIV preexposure prophylaxis medication over a 2‐year period among a national sample of 7148 PrEP users, United States, 2015 to 2017

Persistence on HIV preexposure prophylaxis medication over a 2‐year period among a national sample of 7148 PrEP users, United States, 2015 to 2017

National trends in HIV pre‐exposure prophylaxis awareness, willingness and use among United States men who have sex with men recruited online, 2013 through 2017

Global implementation of PrEP for HIV prevention: setting expectations for impact

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