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CDC urges PrEP use, awareness among at-risk groups, providers
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The CDC announced today that more than 1.2 million adults in the United States are estimated to be at risk for new HIV infection and meet current indications for pre-exposure prophylaxis or other effective prevention methods.
Despite this gap in coverage, officials said active public health programs promoting the once-daily pill could increase uptake of the treatment among this substantial portion of the population.
Anne Schuchat
“A growing body of research indicates PrEP is highly effective in preventing HIV infection when taken consistently,” Anne Schuchat, MD, principal deputy director of the CDC, said during a news conference. “PrEP can only make a difference if all health care providers — not just infectious disease specialists — are aware of it and know who can most benefit from it, and if the people at greatest risk for HIV infection know PrEP may be a viable prevention option.”
Many individuals at risk for HIV infection
In a report published today in MMWR, researchers from the CDC’s Division of HIV/AIDS Prevention analyzed population data collected from several national surveys targeting men who have sex with men, heterosexually active adults and injection drug users (IDUs). Researchers determined risk among MSM aged 18 to 59 years by examining reports of condomless sex, STD acquisition and number of partners. IDUs considered at-risk were those aged 18 years or older who reported any injection drug use during the past 12 months with a previously used needle while heterosexual men and women considered at-risk were aged 18 to 44 years and reported either sex with an HIV-infected partner, or condomless sex within the previous 4 weeks and sex with a high-risk partner within the previous 12 months. The researchers then assessed the prevalence of these high-risk behaviors — which align with the 2014 indications for PrEP use — within the three populations.
They found that an estimated 24.7% of the MSM population (492,000 persons; 95% CI, 212,000-772,000) reported high-risk behavior and met indications for PrEP use. High-risk behavior was also found among an estimated 18.5% of IDUs (115,000 persons; 95% CI, 45,000-185,000) and 0.4% of heterosexually active adults (634,000 persons; 95% CI, 404,000-846,000). PrEP indication was significantly greater among heterosexually active women than for heterosexually active men (468,000 persons vs. 157,000 persons). The researchers estimated that an estimated total of 1,232,000 U.S. adults (95% CI, 661,000-1,803,000) demonstrate substantial risk for new HIV infection and could benefit from PrEP.
“The large percentage of persons at substantial risk for acquiring HIV infection in some transmission risk groups demonstrates a continuing need for access to, and use of, a broad range of high-impact, clinic-based HIV prevention services that includes increased access to PrEP,” the researchers wrote. “Efforts to increase knowledge of and access to PrEP should accompany efforts to increase early diagnosis and treatment of persons with HIV infection.”
PrEP awareness campaigns improve coverage
Although PrEP is capable of preventing new HIV infection, Schuchat said awareness about the preventive treatment remains low among at-risk individuals and health care providers. However, new data also reported today by the New York State Department of Health (NYSDOH) suggest that public health efforts to inform these groups could have substantial benefits.
The health department’s researchers examined Truvada (emtricitabine/tenofovir disoproxil fumarate, Gilead Sciences) prescription rates in the state’s Medicaid program from July 2012 to June 2015. During this time, New York initiated efforts to disseminate information about the treatment through the NYSDOH website, training activities, public forums and toolkits distributed to primary care providers. PrEP use was determined using Medicaid codes to identify continuous use of Truvada for more than 30 days, and excluded prescriptions for post-exposure prophylaxis (PEP), current HIV treatment and chronic hepatitis B virus infection.
Eugene McCray
They found an increase from 259 filled PrEP prescriptions within 1 year (July 2012 to June 2013) to 1,330 filled prescriptions (July 2014 to June 2015). There were 1,708 New York Medicaid recipients who filled at least one prescription of the treatment throughout the full study period, 80.7% of whom resided in New York City and 82.4% of whom were enrolled in Medicaid managed care plans.
“This type of effort needs to be replicated nationally,” Eugene McCray, MD, director of the CDC’s Division of HIV/AIDS Prevention, said during the news conference. “CDC is working on many fronts to ensure people know about PrEP and can access the drug, if they choose to.
“In addition to our 2014 clinical guidelines, we’ve also discussed, provided and developed step-by-step PrEP checklists and interview guides, and we support a hot line to answer questions from providers about when and how to offer PrEP.”
Although PrEP use can greatly reduce new disease in those most likely to be infected, CDC officials stressed that ending the HIV epidemic also will rely on other tools for HIV prevention and care, such as HIV testing, condom use, PEP and ART.
Jonathan H. Mermin
“Clinicians are operating within a highly complex HIV prevention landscape,” Jonathan H. Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention, said during the conference. “Though PrEP is promising and can help fill gaps, no single tool will be sufficient to end the HIV epidemic in the United States. To maximize the success of our national HIV prevention efforts, we must use all the tools we have to achieve meaningful results.” – by Dave Muoio
Disclosures: Schuchat, McCray, Mermin and the researchers report no relevant financial disclosures.
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