PrEP disparities worsened in recent years, study finds

A retrospective analysis showed increasing disparities in HIV PrEP uptake between early and late adopting states between 2014 and 2018, researchers reported.

“We were interested in whether early adoption of HIV PrEP is a predictor of more rapid year-to-year gains, so we studied state-level and region-level trends in uptake of PrEP from 2014 to 2018,” Kathleen A. McManus, MD, MSCR, assistant professor of infectious diseases and international health at the University of Virginia, told Healio.

McManus and colleagues performed a descriptive retrospective study of PrEP uptake in the United States at the state and regional level using data on patients with PrEP prescriptions and people with indications for PrEP between 2014 and 2018. They calculated PrEP uptake using state-level numbers of individuals with PrEP prescriptions as the numerators and state-level estimates of individuals with indications for PrEP as the denominators.

“To understand if the rate of uptake was dependent on prior levels of coverage, we estimated the association between current prevalence of PrEP use and the percentage point change in uptake into the following year using linear regression and controlling for year to account for overall secular changes,” they explained. “We also assessed whether uptake was associated with region using linear regression and whether the association between PrEP uptake and change in uptake into the following year was heterogeneous by region by including an interaction term and conducting a likelihood ratio test.”

Kathleen A. McManus

They estimated the disparity in PrEP uptake between the 10 states with the highest initial PrEP uptake in 2014 (early adopters) and the 10 states with the lowest uptake in 2014 (late adopters) for all years between 2014 and 2018.

Overall, the study demonstrated worsening disparities in PrEP uptake between both early and late adopting states from 2014 to 2018, the researchers said. According to the findings, on average, every 5% of baseline use was related to a 1.2% increase in uptake in the following year, meaning that early adopters are “having big gains” and underperforming states are “not catching up,” McManus said.

Massachusetts, New York and Connecticut remained among the top five states with the highest PrEP uptake, and Idaho, Montana and Wyoming were consistently among the lowest five uptake states, the researchers reported.

“To end the HIV epidemic, federal and state governments must close gaps by translating successful policies from early adopting states to late adopting states. Some considerations include facilitating local and state level policy environments that reduce barriers to PrEP, expanding Medicaid in all states, Tele-PrEP programs, and PrEP drug assistance programs modeled after AIDS Drug Assistance Programs,” McManus said. “Clinicians can advocate for these changes to federal and state government. For the individual clinician, the take-home message is that all clinicians need to be looking for more opportunities to discuss PrEP with patients.”