SAN DIEGO — Prescriptions for pre-exposure prophylaxis, or PrEP, for HIV prevention have risen almost 1,000% in New York City over the past 2 years, although socioeconomic and gender disparities in PrEP access persist, according to new research presented at IDWeek.
Other research shared at the meeting showed that nationally, PrEP awareness among health care providers remains inadequate. Experts said this knowledge gap highlights the need for increased education on the benefits of PrEP, which reduces HIV risk by more than 90%.
The CDC recommends PrEP (tenofovir/emtricitabine) for everyone at very high risk for HIV. This includes about 1.2 million Americans, of whom only 10% are currently taking prep, according to Rajesh T. Ghandi, MD, FIDSA, IDWeek HIV Medical Association Chair, from Massachusetts General Hospital, who moderated a press conference on the research.
Ninefold increase in NYC
An analysis of EHR records from more than 600 ambulatory care practices in NYC showed PrEP prescriptions increased from 38.9 to 418.5 per 100,000 patients seen between the first quarter of 2014 to the second quarter of 2016 — a 976% increase.
“We found … an over nine-fold increase in PrEP prescribing rates among this sample,” Paul Salcuni, MPH, study author and data analyst at the Bureau of HIV/AIDS Prevention and Control at the NYC Department of Health and Mental Hygiene, said during the press conference.
He and colleagues credited this increase to the CDC PrEP guidelines released in 2014, clinical trials and demonstration projects showing the effectiveness of PrEP, and a variety of education campaigns launched in the city.
However, an analysis of patient and practice factors revealed significant disparities in PrEP access. Although increases in PrEP prescriptions were significant for both men and women (P < .0001), the vast majority of prescriptions were among men.
“About 95% of PrEP prescriptions were among males in the second quarter of 2016,” Salcuni said.
Analysis of PrEP prescription rates by sex showed that prescriptions increased from 7.4 to 32.4 per 100,000 female patients seen during the study period, compared with 89.5 to 1,036.4 per 100,000 male patients seen.
Other disparities included differences in prescription rates across age groups, and between different racial and ethnic groups.
“Younger male patients and white male patients were more likely than men of color and older male patients to be prescribed PrEP among this sample,” Salcuni said.
Men aged 18-29 years were almost three times as likely to be prescribed PrEP than older men (adjusted rate ratio; 2.8; 95% CI, 2.4-3.4), and men of color were about half as likely to be prescribed PrEP than white men (adjusted RR for black men; 0.6; 95% CI, 0.4-0.9).