PrEP Use Disparities Worsening Between Early and Late Adopting States

PrEP use is estimated to prevent >90% of infections in men who have sex with men and 70% of infections in people who inject drugs.

A recent study conducted by investigators from the Division of Infectious Diseases and International Health at the University of Virginia, in collaboration with the National Alliance of State and Territorial AIDS Directors, has found that disparities in preexposure prophylaxis (PrEP) use among individuals with PrEP indications worsened between early and late adopting states between 2014 and 2018.

Results from the study were published in the journal Open Forum Infectious Diseases.

“Recent work suggests the importance of social networks and peer effects in reducing PrEP stigma and increasing PrEP knowledge. This potentially explains why greater PrEP uptake is related to greater increase in PrEP usage into the next year,” the authors wrote. “More users implies greater potential for community-based information spread.”

In 2012, the US Food and Drug Administration (FDA) adopted the “Plan to End the HIV Epidemic” (EHE), which prioritized state and county level partnerships to prevent >250,000 new HIV infections over 10 years.

For the study, the team of investigators performed a descriptive retrospective study of PrEP uptake using data on individuals with PrEP prescriptions and individuals with indications for PrEP between 2014 and 2018.

Data was obtained from the online database AidsVu.org to calculate state-level numbers of individuals with PrEP prescriptions and estimates of those with indications for PrEP were gathered from data published by the US Centers for Disease Control and Prevention (CDC) between the years 2014 and 2018.

Findings from the study demonstrated that the greatest uptake in PrEP use was seen in the Northeastern US, followed by the Midwest, the West and the South. Higher PrEP use was associated with greater PrEP uptake in the following year across the entire study period.

This data shows that the disparities between high-uptake and low-uptake states increased between 2014 and 2018.

Additionally, the association between current PrEP uptake with change in PrEP uptake into the next year did not differ between regions.

“With disparities in PrEP uptake worsening, federal and state health policies must align with broader EHE goals to ensure the plan’s success for all communities,” the authors wrote. “Further research on PrEP uptake should be conducted to target these policy proposals.”