Infectious Disease

PrEP disparities have worsened in recent years, study results

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Disclosure:
McManus reports that he has received a research grant from Gilead Sciences initiated by researchers, as well as an equity stake in Gilead Sciences.

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A retrospective analysis showed increasing disparities in HIV PrEP uptake between early and late adoption states between 2014 and 2018, the researchers reported.

“We were interested in whether an early introduction of HIV-PrEP would be a predictor of faster growth from year to year, so we examined the trends in PrEP use at the federal and regional level from 2014 to 2018.” Kathleen A. McManus, MD, MSCR, Assistant Professor of Infectious Diseases and International Health at the University of Virginia, Healio said.

PrEP pill

The researchers observed worsening disparities in PrEP uptake between early and late adoptive states between 2014 and 2018.
Source: Adobe Stock.

McManus and colleagues conducted a descriptive retrospective study of PrEP uptake in the United States at the state and regional levels between 2014 and 2018, using data on patients with PrEP prescriptions and those with PrEP indications. They calculated PrEP uptake using state-level numbers of people with PrEP ordinances as the numerator and state-level estimates of people with indications for PrEP as the denominator.

“To understand whether the admission rate depends on previous coverage, we estimated the relationship between the current prevalence of PrEP use and the percentage change in admission in the following year using a linear regression and a control for the year to to take into account the overall secular changes, ”they explained. “We also examined whether uptake was associated with region using linear regression and whether the association between PrEP uptake and change in uptake in the following year was heterogeneous by region by including an interaction term and a likelihood -Ratio test performed. “

Kathleen A. McManus

They estimated the disparity in PrEP take-up between the 10 states with the highest initial PrEP take-up in 2014 (early adopters) and the 10 states with the lowest take-up in 2014 (late adopters) for all years between 2014 and 2018.

Overall, the study showed that differences in PrEP use between early and late adoptive states worsened from 2014 to 2018, the researchers said. The results found, on average, every 5% of basic consumption was associated with a 1.2% increase in use the following year, meaning early adopters “make big profits” and low-performing states “don’t catch up,” McManus said.

Massachusetts, New York, and Connecticut remained among the five states with the highest PrEP intake, and Idaho, Montana, and Wyoming were all among the five states with the lowest intake, the researchers reported.

“To end the HIV epidemic, federal and state governments must fill the loopholes by transferring successful policies from early adoptive states to late adoptive states. Some considerations include easing local and state-level political environments, removing barriers to PrEP, expanding Medicaid across states, tele-PrEP programs, and PrEP drug support programs along the lines of AIDS drug support programs, ”said McManus. “Hospitals can campaign for these changes in the federal and state government. For the individual clinician, the takeaway message is that all clinicians need to look for more ways to talk to patients about PrEP. “

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