US: PrEP use growing but not reaching all those in need

The number of people taking HIV pre-exposure prophylaxis (PrEP) in the United States is steadily increasing, exceeding 77,000 in 2016, according to figures released yesterday by AIDSVu in conjunction with the 25th Conference on Retroviruses and Opportunistic Infections (CROI 2018) in Boston.

But PrEP is only reaching a small proportion of those who could benefit from it. Among the estimated 1.1 million people nationwide who are potential candidates for PrEP, only 8% are receiving it, according to new data from the US Centers for Disease Control and Prevention (CDC). Although African Americans and Latinos make up about two-thirds of people who stand to benefit from PrEP, they are much less likely than white people to be using it.

AIDSVu numbers

The US Food and Drug Administration approved Truvada (tenofovir/emtricitabine) for HIV prevention in July 2012. It has been difficult to estimate the total number of people using PrEP because this information is not centrally collected.

For the past several years Gilead Sciences, the maker of Truvada, has been reporting PrEP use estimates based on surveys of commercial pharmacies. At the International AIDS Society Conference on HIV Science last summer, Gilead researchers reported that an estimated 120,000 people had ever started Truvada for PrEP since 2012.

Now, Gilead has teamed up with researchers at Emory University's Rollins School of Public Health to make the latest PrEP numbers available via AIDSVu, an interactive online map of the US HIV/AIDS epidemic.

The new figures presented in AIDSVu show the number of individuals who were prescribed Truvadafor HIV prevention during 2016. Anonymous data were obtained from Source Healthcare Analytics (SHA) and compiled by Emory researchers led by AIDSVu principal scientist Patrick Sullivan.

SHA collects data from more than 54,000 pharmacies, 1500 hospitals, 800 outpatient facilities and 80,000 physician practices across the US. It includes prescriptions paid for in cash or by private insurance, Medicaid or Medicare (programmes for low-income people and seniors, respectively) or patient assistance programmes. It does not include PrEP obtained from other sources including demonstration studies, military and veterans' health systems and managed care providers that run their own pharmacies (such as Kaiser Permanente). The CDC estimates that 85 to 90% of PrEP prescriptions are filled at commercial pharmacies.

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