Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Dec;28(12):841-849.
doi: 10.1016/j.annepidem.2018.06.005. Epub 2018 Jun 15.

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

Aaron J Siegler  1 , Farah Mouhanna  2 , Robertino Mera Giler  3 , Kevin Weiss  4 , Elizabeth Pembleton  4 , Jodie Guest  4 , Jeb Jones  4 , Amanda Castel  5 , Howa Yeung  6 , Michael Kramer  4 , Scott McCallister  3 , Patrick S Sullivan  4
Affiliations

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

Aaron J Siegler et al. Ann Epidemiol. 2018 Dec.

Abstract

Purpose: The number of individuals who have started a regimen for HIV pre-exposure prophylaxis (PrEP) in the United States is not well characterized but has been on the rise since 2012. This analysis assesses the distribution of PrEP use nationally and among subgroups.

Methods: A validated algorithm quantifying tenofovir disoproxil fumarate/emtricitabine for PrEP in the United States was applied to a national prescription database to determine the quarterly prevalence of PrEP use. HIV diagnoses from 2016 were used as an epidemiological proxy for PrEP need. The PrEP-to-need ratio (PnR) was defined as the number of PrEP users divided by new HIV diagnoses.

Results: A total of 70,395 individuals used PrEP in the fourth quarter of 2017: 67,166 males and 3229 females. Nationally, prevalence of PrEP use was 26/100,000 (range across states per 100,000 [RAS/100k]: 4-73) and the PnR was 1.8 (RAS: 0.5-6.6). Prevalence of PrEP use among males and females, respectively, was 50/100,000 and 2/100,000 (RAS/100k: 7-143 and 0.3-7) and PnR was 2.1 and 0.4 (RAS: 0.6-7.1 and 0.1-4.0). Prevalence of PrEP use was lowest among individuals aged less than or equal to 24 and more than or equal to 55 years (15/100,000 and 6/100,000, RAS/100k: 1-45 and 0.4-14), with PnR 0.9 and 1.5 (RAS: 0.2-5.6 and 0.3-7.0). The Northeast had the highest PnR (3.3); the South had the lowest (1.0). States with Medicaid expansion had more than double the PnR than states without expansion.

Conclusions: Available data suggest that females, individuals aged less than or equal to 24 years and residents of the South had lower levels of PrEP use relative to epidemic need. These results are ecological, and misclassification may attenuate results. PnR is useful for future assessments of HIV prevention strategy uptake.

Keywords: HIV; Pre-exposure prophylaxis; Prevention.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Lorenz curve of PrEP use by population by state, Q4 2017 United States
Figure 2
Figure 2
Lorenz curve of PrEP use by new HIV cases by state, Q4 2017 United States
Figure 3
Figure 3
The prevalence of PrEP users and the PrEP-to-need ratio by state, Q4 2017
See this image and copyright information in PMC

References

    1. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. The New England journal of medicine. 2010;363(27):2587–2599. - PMC - PubMed
    1. Anderson PL, Glidden DV, Liu A, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Science translational medicine. 2012;4(151):151ra125. - PMC - PubMed
    1. Hanscom B, Janes HE, Guarino PD, et al. Preventing HIV-1 Infection in Women using Oral Pre-Exposure Prophylaxis: A Meta-analysis of Current Evidence. Journal of acquired immune deficiency syndromes (1999) 2016;73(5):606–608. - PMC - PubMed
    1. Choopanya K, Martin M, Suntharasamai P, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. The Lancet. 381(9883):2083–2090. - PubMed
    1. Martin M, Vanichseni S, Suntharasamai P, et al. The impact of adherence to preexposure prophylaxis on the risk of HIV infection among people who inject drugs. Aids. 2015;29(7):819–824. - PubMed

Publication types

MeSH terms

Substances