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
. 2020 Dec 15;71(12):3144-3151.
doi: 10.1093/cid/ciz1229.

Evidence of an Association of Increases in Pre-exposure Prophylaxis Coverage With Decreases in Human Immunodeficiency Virus Diagnosis Rates in the United States, 2012-2016

Dawn K Smith  1 , Patrick S Sullivan  2 , Betsy Cadwell  1 , Lance A Waller  3 , Azfar Siddiqi  1 , Robertino Mera-Giler  4 , Xiaohong Hu  1 , Karen W Hoover  1 , Norma S Harris  1 , Scott McCallister  4
Affiliations

Evidence of an Association of Increases in Pre-exposure Prophylaxis Coverage With Decreases in Human Immunodeficiency Virus Diagnosis Rates in the United States, 2012-2016

Dawn K Smith et al. Clin Infect Dis. .

Abstract

Background: Annual human immunodeficiency virus (HIV) diagnoses in the United States (US) have plateaued since 2013. We assessed whether there is an association between uptake of pre-exposure prophylaxis (PrEP) and decreases in HIV diagnoses.

Methods: We used 2012-2016 data from the US National HIV Surveillance System to estimate viral suppression (VS) and annual percentage change in diagnosis rate (EAPC) in 33 jurisdictions, and data from a national pharmacy database to estimate PrEP uptake. We used Poisson regression with random effects for state and year to estimate the association between PrEP coverage and EAPC: within jurisdictional quintiles grouped by changes in PrEP coverage, regressing EAPC on time; and among all jurisdictions, regressing EAPC on both time and jurisdictional changes in PrEP coverage with and without accounting for changes in VS.

Results: From 2012 to 2016, across the 10 states with the greatest increases in PrEP coverage, the EAPC decreased 4.0% (95% confidence interval [CI], -5.2% to -2.9%). On average, across the states and District of Columbia, EAPC for a given year decreased by 1.1% (95% CI, -1.77% to -.49%) for an increase in PrEP coverage of 1 per 100 persons with indications. When controlling for VS, the state-specific EAPC for a given year decreased by 1.3% (95% CI, -2.12% to -.57%) for an increase in PrEP coverage of 1 per 100 persons with indications.

Conclusions: We found statistically significant associations between jurisdictional increases in PrEP coverage and decreases in EAPC independent of changes in VS, which supports bringing PrEP use to scale in the US to accelerate reductions in HIV infections.

Keywords: HIV diagnoses; HIV prevention; PrEP; prophylaxis.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Quintiles of change in PrEP coverage, by state, United States, 2012–2016. State abbreviations can be found at https://www.50states.com/abbreviations.htm. Abbreviation: PrEP, pre-exposure prophylaxis.
Figure 2.
Figure 2.
Average EAPC stratified by quintiles of change in PrEP coverage, United States, 2012–2016. Abbreviations: DC, District of Columbia; EAPC, estimated annual percentage change; HIV, human immunodeficiency virus; PrEP, pre-exposure prophylaxis.
Figure 3.
Figure 3.
Changes in tenofovir disoproxil fumarate/emtricitabine PrEP coverage and HIV diagnosis rates, in the District of Columbia and 5 state quintiles, United States (US), 2012–2016. Abbreviations: DC, District of Columbia; EAPC, estimated annual percentage change; HIV, human immunodeficiency virus; PrEP, pre-exposure prophylaxis.
See this image and copyright information in PMC

Comment in

References

    1. Centers for Disease Control and Prevention. Atlas Plus 2019. Available at: https://www.cdc.gov/nchhstp/atlas/index.htm. Accessed 19 February 2019.
    1. Centers for Disease Control and Prevention. HIV surveillance report, 2017 Available at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveil.... Accessed 2 January 2019.
    1. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010–2016. HIV Surveillance Supplemental Report 2019 Available at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveil.... Accessed 3 March 2019.
    1. Sullivan PS, Giler RM, Mouhanna F, et al. Trends in the use of oral emtricitabine/tenofovir disoproxil fumarate for pre-exposure prophylaxis against HIV infection, United States, 2012–2017. Ann Epidemiol 2018:28:833–40. - PMC - PubMed
    1. Centers for Disease Control and Prevention. CDC fact sheet: trends in U.S. HIV diagnoses, 2005-2014 Available at: https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/hiv-data-trends-fac.... Accessed 10 June 2018.

Publication types

Substances