Pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM) in high-prevalence areas increased approximately 500% from 2014 to 2017, new data from the US Centers for Diseases Control Prevention (CDC) show, although uptake among other key vulnerable populations remains lower.
CDC investigators pulled National HIV Behavioral Surveillance data for 2014 and 2017 in order to analyze PrEP use and awareness progress and to measure alignment with the Ending the HIV Epidemic
initiative. Statistics were presented in the CDC’s Morbidity and Mortality Weekly Report
dated July 12.
The report contained interviews with 18,610 sexually active MSM (9640 in 2014; 8970 in 2017) in 20 urban areas, of which 7873 (42%) had a negative HIV test but were considered at risk for HIV infection and, thus, prime PrEP candidates (3821 [40%] in 2014; 4052 [45%] in 2017).
PrEP awareness among these MSM rose from 60% to 90% from 2014 to 2017 (adjusted prevalence ratio [aPR] = 1.45; 95% CI = 1.41–1.50), and PrEP use increased from 6% to 35% (aPR = 5.66; 95% CI = 4.85–6.61).
“Although PrEP use by MSM in this analysis increased approximately 500% from 2014 to 2017, only approximately 1 in 3 men at risk for HIV infection reported using PrEP,” investigators wrote. “Models examining the impact of PrEP use on incidence predict that the use of PrEP by 30%-40% of MSM with PrEP indications in a community could result in approximately one third of new HIV infections being averted over a 10-year period, with a greater predicted impact if coverage is increased.”
Additionally, PrEP use increased across nearly all demographic subgroups from 2014 to 2017, but it remained lower among black (3.8% in 2014; 26.2% in 2017) and Hispanic MSM (3.8% in 2014; 30% in 2017).
"Although PrEP awareness and use has increased among persons at risk for HIV in the US, coverage remains too low especially among black and Hispanic MSM," Jason Schafer, PharmD, associate professor of pharmacy practice at Thomas Jefferson University in Philadelphia and the HIV section editor for Contagion®
, said. "PrEP cost and access disparities remain important barriers for many patients. Missed opportunities to prescribe PrEP by health care providers also remain too common. Although promising, the data suggest that much more work is necessary to ensure routine PrEP access for the people who need it most."
Teresa Finlayson, PhD, epidemiologist in CDC’s Division of HIV/AIDS Prevention, and lead author of the MMWR
report, explained some of the other obstacles to these demographic groups' uptake of PrEP.
"Special efforts are urgently needed to increase PrEP access among African Americans and Latinos, who disproportionately face poverty, discrimination, and limited access to health care, which can all increase HIV risk and stop people from obtaining HIV prevention services," she told Contagion®
. "It is also important to overcome other obstacles that may reduce opportunities to access PrEP—such as mistrust of and lack of connection with the medical system among some African American and Latino gay and bisexual men."
Investigators also emphasized the role health care providers can play in cutting down on the rate of new HIV infections by recommending testing and PrEP use for at-risk patients.
"These new data are a reminder that clinicians can play a central role in offering PrEP to people who could benefit from it, and to helping close gaps by race/ethnicity in PrEP use," Finlayson said. "Clinicians can help by routinely testing their patients for HIV, assessing HIV-negative patients for risks, and prescribing PrEP as needed."
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