Despite improvement in new PrEP use, racial, ethnic ‘disparities still persist’
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Key takeaways:
- Those living in Black or Hispanic neighborhoods or who were on Medicaid had lower proportions of new PrEP use.
- Meanwhile, men and women without risk factors for HIV had the highest unmet needs from 2019 to 2023.
Access to pre-exposure prophylaxis remains insufficient, especially among Black, Hispanic and Medicare-insured populations, results of an analysis presented at IDWeek suggested.
The findings showed increases in PrEP use across all subgroups, with the largest gains reported among men and women with no risk factors for HIV-1 infection, according to researchers.
According to CDC data, 31,800 estimated new cases of HIV infection occurred in the United States in 2022, although HIV cases have decreased by 12% overall from 2018 to 2022.
Pre-exposure prophylaxis, or PrEP, “is a very important strategy for HIV prevention, and there are many options on the market in the U.S. for PrEP,” Li Tao, MD, PhD, director of real-world evidence and epidemiology at Gilead Sciences, said during a press briefing. “While uptake has been increasing throughout the years, disparities still persist in PrEP uptake and initiation across diverse population groups.”
Tao and colleagues, who aimed to capture trends within PrEP initiation and determine which populations have the most unmet needs, analyzed data obtained from an IQVIA claims database on PrEP prescriptions and new diagnoses of HIV between 2019 and 2023.
They also examined demographic data, such as the predominant races and ethnicities of neighborhoods, sex and insurance types, to establish PrEP-to-need ratios, defined as the amount of people using PrEP each year divided by the amount of new HIV diagnoses in the past year for several subpopulations, according to a press release.
The researchers found that a large proportion of new PrEP users in both 2019 (53%) and 2023 (43%) included men who were at risk for HIV, using commercial insurance and residing in predominantly white neighborhoods.
They pointed out that this group had the lowest unmet needs and a small annual increase of 2% in PrEP initiation.
Men at risk for HIV, either those using commercial insurance and residing in predominantly Black or Hispanic neighborhoods or those on Medicaid across all neighborhoods, had higher unmet needs and lower proportions of new PrEP use (16% in 2019 and 17% in 2023) despite a yearly increase of 11% in initiation.
Women and men without risk factors for HIV had the highest annual increases in PrEP initiation at 30% and 19%, respectively, but still had the greatest unmet needs over the study period.
“The findings indicate that while PrEP-to-need ratio improvement [was] observed across all groups... the disparities still persist,” Tao said. “We think that identifying the priority populations with unmet needs in PrEP is very crucial for guiding future HIV prevention options.”
Long-acting PrEP options “may help to address some social determinant structural factors in HIV acquisition, such as the partners’ behaviors and the lack of providers willing to provide PrEP in underserved populations,” she added.
References:
- Fast facts: HIV in the United States. Available at: https://www.cdc.gov/hiv/data-research/facts-stats/index.html. Accessed Oct. 11, 2024.
- Pre-exposure prophylaxis access multifaceted; Unmet needs remain. Available at: https://www.idsociety.org/news--publications-new/articles/2024/pre-exposure-prophylaxis-access-multifaceted-unmet-needs-remain. Published Oct. 16, 2024. Accessed Oct. 16, 2024.
- Tao L, et al. Abstract 204. Presented at: IDWeek, Oct. 16-19, 2024; Los Angeles.
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