PrEP not reaching those who could potentially benefit from it the most

March 8, 2018

A new CDC study suggests that only a small percentage of Americans who could potentially benefit from pre-exposure prophylaxis (PrEP), a daily pill for HIV prevention, have been prescribed it. In the first detailed analysis by race and by risk group, CDC researchers found while two-thirds of those who could potentially benefit from PrEP are African American or Latino, these groups account for the smallest percentage of prescriptions to date.

Key findings:

• In 2015, there were approximately 1.1 million Americans who could potentially benefit from PrEP according to CDC guidelines, including:
• 500,000 African Americans
• 300,000 Latinos
• 300,000 whites

However, during a similar time period (September 2015 – August 2016), prescriptions filled at retail pharmacies or mail order services included as few as:
• 7,000 for African Americans
• 7,600 for Latinos
• 42,000 for whites

Improving access to PrEP

Although primary care providers are qualified to provide PrEP, an unpublished 2015 survey of US healthcare providers found that 34 percent had not heard of it, according to the report.

While the survey suggests that two-thirds of providers are at least familiar with PrEP, that does not necessarily mean they are comfortable providing it, CDC principal deputy director Ann Schuchat told reporters. “The bottom line is doctors need more prep about PrEP.”

It has been difficult to get a handle on how many people have received PrEP to date. A survey covering about 40 percent of US pharmacies by Gilead Sciences found that more than 8500 individuals have been prescribed Truvada for PrEP since the beginning of 2012. However, this is an underestimate as it does not include people receiving PrEP through clinical trials, demonstration projects, Medicaid (coverage for low-income individuals), Gilead’s patient assistance program or non-reporting health facilities. Altogether, experts estimate that the total number of people on PrEP in the US may reach at least 25,000.

Concerted efforts could substantially increase the number of people with access to PrEP, according to a second analysis also published in the November 27 edition of Morbidity and Mortality Weekly Report.

Franklin Laufer and colleagues with the New York State Department of Health looked at changes in PrEP use after the governor adopted a plan to end the AIDS epidemic in June 2014. The plan includes an effort to increase knowledge about PrEP, train providers and ensure Medicaid coverage. Approximately 3000 new cases of HIV infection occur in New York State each year, the authors noted as background, and about a quarter of state residents are covered by Medicaid.

The researchers found that the number of New York residents on Medicaid who filled prescriptions for Truvada for PrEP increased by more than 300 percent – or more than four-fold – rising from 259 between July 2012 and June 2013 and 303 between July 2013 and June 2014, to 1330 between July 2014 and June 2015.

However, they added, “Although the increase in percentage of Medicaid recipients filling Truvada prescriptions for PrEP…is substantial, the number of persons doing so remains low relative to the number needed to treat in order to achieve the goals of New York state’s Ending the AIDS Epidemic initiative.”

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