Trends in the use of oral emtricitabine/tenofovir disoproxil fumarate for pre-exposure prophylaxis against HIV infection, United States, 2012–2017

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

doi:10.1016/j.annepidem.2018.06.009

Cited by 184 publications

(152 citation statements)

References 25 publications

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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 [15], and with current PrEP prevalence data that find comparatively low prevalence of PrEP use for these groups [14]. 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 [25,26].…”

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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“…In the United States, estimates range from 12,000-200,000 individuals taking PrEP in 2017 [5,6]. Recent gains in increasing PrEP prescriptions may be leveling off, [5] far short of the 1.1 Mio. persons the Centers for Disease Control and Prevention (CDC) estimates are indicated for PrEP [6].…”

Section: Introductionmentioning

confidence: 99%

“…Progress in scaling up PrEP has not been uniform. One metric, the PrEP-to-need ratio, describes disparities in PrEP scale-up by comparing the number of new PrEP prescriptions relative to the number of new HIV diagnoses; the metric identified women, younger persons, and the Southern US region as having low PrEP-to-need ratios [5,7]. Structural barriers contribute to these disparities; for instance, counties with higher concentrations of residents living in poverty are less likely to have a PrEP-prescribing clinic [9].…”

Section: Introductionmentioning

confidence: 99%

Validation of the HIV Pre-exposure Prophylaxis Stigma Scale: Performance of Likert and Semantic Differential Scale Versions

et al. 2020

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Stigma regarding HIV pre-exposure prophylaxis (PrEP) is commonly implicated as a factor limiting the scale-up of this highly effective HIV prevention modality. To quantify and characterize PrEP stigma, we developed and validated a brief HIV PrEP Stigma Scale (HPSS) among a group of 279 men who have sex with men (MSM). Scale development was informed by a theoretical model to enhance content validity. We assessed two scale versions, Semantic Differential and Likert, randomizing the order in which scales were presented to participants. Both scales demonstrated high internal consistency. The Likert scale had substantially better construct validity and was selected as the preferred option. Scale scores demonstrated construct validity through association with constructs of interest: healthcare distrust, HIV knowledge, perceived proportion of friends/partners on PrEP, perceived community evaluation of PrEP, and perceived effectiveness of PrEP. The scale accounted for 25% of the total variance in reported willingness to be on PrEP, indicating the substantial role PrEP stigma may have on decisions to initiate PrEP. Given increased efforts to roll-out PrEP, having a valid tool to determine the level and types of PrEP stigma in individuals, groups, and communities can help direct implementation plans, identify goals for stigma reduction, and monitor progress over time.

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“…A recently published analysis documented a 56% estimated annual percentage change in the prevalence of PrEP use in the United States from 2012 to 2017. 7 However, persistent disparities in PrEP access remain, with black and Latino individuals, younger individuals, women, and those residing in the southern states having the lowest access. 8,9 The next 3-year phase for PrEP implementation (2019)(2020)(2021) should focus on integration, that is, the assimilation of PrEP provision as an integral part of HIV prevention, sexual health, and primary care.…”

Section: Introductionmentioning

confidence: 99%

Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men

Golub

Myers

2019

AIDS Patient Care and STDs

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Data indicate that diffusion of pre-exposure prophylaxis (PrEP) programs for HIV prevention is increasing in the United States; however, persistent disparities in PrEP access remain. Earlier waves of PrEP implementation focused on development (2012)(2013)(2014)(2015) and diffusion (2016)(2017)(2018). To reduce disparities, the next wave of PrEP implementation should focus on integration; that is, the assimilation of PrEP service as an integral part of HIV prevention, sexual health, and primary care. This review analyzes PrEP implementation literature in the context of three ''next-wave'' challenges: increasing patient demand, enhancing provider investment and competency, and improving health systems capacity. Our review revealed five activities we consider critical to successful next-wave PrEP implementation efforts: (1) redefining PrEP eligibility assessment, (2) de-emphasizing risk perception as a strategy to increase demand, (3) rejecting risk compensation arguments, (4) altering guidelines to make PrEP follow-up less onerous, and (5) focusing directly on strategies to reduce the cost of PrEP medication. This article ends with a case study of a research-practice partnership designed to instantiate new approaches to integrative implementation efforts.

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Trends in the use of oral emtricitabine/tenofovir disoproxil fumarate for pre-exposure prophylaxis against HIV infection, United States, 2012–2017

Abstract: Despite overall increases in the annual number of TDF/FTC PrEP users in the US from 2012 to 2017, the growth of PrEP coverage is inconsistent across groups. Efforts to optimize PrEP access are especially needed for women and for those living in the South.

Cited by 184 publications

References 25 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

Validation of the HIV Pre-exposure Prophylaxis Stigma Scale: Performance of Likert and Semantic Differential Scale Versions

Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men

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