Comparing Access, Usage of PrEP in Newly Diagnosed vs Patients Living With HIV

With the goal to end the HIV epidemic by 2030 in mind, researchers of a recent study conducted an analysis in which they found that a significant proportion of individuals that could benefit from preexposure prophylaxis (PrEP) were not receiving the medication, and those who did had drastically different characteristics than the most at-risk population.

Stephanie S Chan, MD, US Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy, Washington, DC, and colleagues, conducted a study in which they: “(1) compared the characteristics of patients who were prescribed PrEP with individuals newly diagnosed with HIV infection; (2) identified the specialties of practitioners prescribing PrEP; (3) identified metropolitan statistical areas (MSAs) within the US where there is relatively low uptake of PrEP; and (4) reported median amounts paid by patients and third-party payors for PrEP.”

Using September 2015 through August 2016 prescription drug claims data from Sympony Health’s Integrated Dataverse, Dr Chan and colleagues examined PrEP patients, prescribers, relative uptake and payment methods for 75,839 patients. Findings were extrapolated to approximately 101,000 individuals, which the authors noted is less than 10% of the 1.1 million adults for whom PrEP was indicated.

When comparing newly diagnosed HIV infection patients, the researchers found that PrEP patients were more likely to be non-Hispanic white (45% vs 26.2%), older (25% vs 19% at ages 35-44), male (94% vs 81%), and not reside in the South (30% vs 52% reside in the South).

Further, MSAs with low uptake of PrEP were found to be concentrated in the South.

About two-thirds of the 24,000 providers who prescribed PrEP listed primary care as their specialty.

In terms of costs, Dr Chan and colleagues observed that PrEP patients were more likely to have used commercial health insurance (80% vs 35%) than the newly diagnosed cohort and less likely to have used public health care coverage or a publicly sponsored assistance program (12% vs 45% for Medicaid). The researchers estimate that annual per patient out-of-pocket spending on PrEP was approximately $72.

The following limitations were reported: missing information on prescription claims of patients not included in the database, and for those included, some patients were missing information on patient diagnosis, race/ethnicity, educational attainment, and income (34%-36%).

“Our findings indicate that in 2015-2016, many individuals in the US who could benefit from being on PrEP were not receiving this HIV prevention medication, and those prescribed PrEP had a significantly different distribution of characteristics from the broader population that is at risk for acquiring HIV,” concluded Dr Chan and colleagues. "Addressing the affordability of PrEP and otherwise promoting its use among those with indications for PrEP represents an important opportunity to help end the HIV epidemic.”

—Edan Stanley

Reference:
Chan SS, Chappel AR, Maddox KEJ, et al. Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015-2016. PLoS Med. 2020;17(4):e1003072. Published 2020 Apr 10. doi:10.1371/journal.pmed.1003072