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
Meta-Analysis
. 2020 Aug 1;84(4):379-386.
doi: 10.1097/QAI.0000000000002345.

Growth in Proportion and Disparities of HIV PrEP Use Among Key Populations Identified in the United States National Goals: Systematic Review and Meta-analysis of Published Surveys

Emiko Kamitani  1 , Wayne D Johnson  1 , Megan E Wichser  2 , Adebukola H Adegbite  2 , Mary M Mullins  1 , Theresa Ann Sipe  1
Affiliations
Meta-Analysis

Growth in Proportion and Disparities of HIV PrEP Use Among Key Populations Identified in the United States National Goals: Systematic Review and Meta-analysis of Published Surveys

Emiko Kamitani et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Pre-exposure prophylaxis (PrEP) use among populations most vulnerable to HIV as identified in the national HIV prevention goals is not fully known. This systematic review assessed trends of lifetime self-reported PrEP use and disparities among key populations.

Methods: We used the CDC HIV/AIDS Prevention Research Synthesis cumulative database of electronic and manual searches in MEDLINE, CINAHL, EMBASE, and PsycINFO from 2000 to 2019 to identify English-language primary studies reporting PrEP use. Two reviewers independently screened citations, extracted data, and assessed the risk of bias with the modified Newcastle-Ottawa Scale. We estimated pooled proportions and crude/adjusted odds ratio.

Results: We identified 95 eligible studies including 95,854 US-based survey respondents. A few studies (6.3%) focused on persons who inject drugs. In 2015-2017, men who have sex with men (MSM) had highest proportion of individuals who used PrEP over their lifetime [13.9% (95% confidence interval: 8.8 to 21.1), k (number of surveys) = 49] followed by Hispanic/Latinos [11.5 (7.1 to 18.1), 12], transgender women [11.2 (5.8 to 20.6), 5], and blacks [9.9 (8.3 to 11.8), 18]. Odds of PrEP use increased by 34%/year [odds ratio = 1.34/year (95% confidence interval: 1.09 to 1.64)] and significantly increased over time among MSM [1.53/year (1.21-1.93)] and blacks [1.44 (1.13-1.83)]. People in the Southern United States [9.9 (4.7-19.7), 8] and youth [7.3 (4.7-11.2), 8] had lower rates and did not demonstrate growth [0.94 (0.29-3.18); 0.82 (0.43-1.55)]. Odds of reporting lifetime PrEP use was twice [2.07 (1.27-3.38)] as great among MSM than non-MSM.

Conclusions: Proportions of PrEP use in published surveys have been growing, but remain low for people in the Southern United States and youth, and understudied in persons who inject drugs. Limitations include few studies in certain years, whereas strengths include a large number of respondents. Culturally tailored approaches targeting vulnerable populations are essential in increasing PrEP use to reduce disparities in HIV acquisition.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Flow diagram of included studies
Figure 2:
Figure 2:
Forest plot of pooled proportions of self-reported pre-exposure prophylaxis (PrEP) use stratified by year (N=95)
Figure 3:
Figure 3:
Growth rate of proportion of self-reported PrEP use within both pre-CDC PrEP clinical guideline era (2004–2014) and post-guideline era (2015–2017) time periods among US study participant
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. N Engl J Med. 2010;363(27):2587–2599. - PMC - PubMed
    1. Liu AY, Cohen SE, Vittinghoff E, et al. Preexposure Prophylaxis for HIV Infection Integrated With Municipal- and Community-Based Sexual Health Services. JAMA Internal Medicine. 2016;176(1):75–84. - PMC - PubMed
    1. McCormack S, Dunn DT, Desai M, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. The Lancet. 2016;387(10013):53–60. - PMC - PubMed
    1. Volk JE, Marcus JL, Phengrasamy T, et al. No new HIV infections with increasing use of HIV preexposure prophylaxis in a clinical practice setting: Figure 1. Clin Infect Dis. 2015;61(10):1601–1603. - PMC - PubMed
    1. Sullivan PS, Smith DK, Mera-Giler R, et al. The impact of pre-exposure prophylaxis with TDF/FTC on HIV diagnoses, 2012–2016, United States. Paper presented at: AIDS; 2018; Amsterdam, Netherlands.

MeSH terms