(193) Screening and Monitoring Testing of HIV Pre-Exposure Prophylaxis Use Among Commercially Insured Patients, 2016-2019

Publication Number: 524

Background: To ensure the health and safety of persons taking pre-exposure prophylaxis (PrEP) to prevent HIV infection, Centers for Disease Control and Prevention (CDC) guidelines recommend initial and follow-up laboratory testing.

Objectives: We assessed the rates and trends of recommended laboratory testing among PrEP users from 2016-2019.

Methods: We conducted a retrospective cohort study, using data from the 2016-2020 MarketScan database, of commercially insured individuals aged 13-64 prescribed ≥ 30 days of tenofovir-disoproxil-fumarate with emtricitabine or tenofovir-alafenamide with emtricitabine for PrEP. To ensure PrEP use, we excluded persons with any diagnostic codes or prescriptions for HIV or hepatitis B virus (HBV) during the year before the first PrEP prescription date (index date) and prescriptions ( <30 days) for post-exposure prophylaxis use. We assessed the proportion of PrEP users tested for: 1) HIV, creatinine, HBV, hepatitis C virus (HCV), and sexually transmitted infection (STI) tests (chlamydia/gonorrhea and syphilis) in the 7 days before (initial tests); 2) HIV, creatinine, and STI tests 180 days after (follow-up tests) index date. We used linear regression to examine trends and multivariable logistic regression to identify predictors of ≥ 1 HIV test after 180 days of index PrEP.

Results: We identified 17714 new PrEP users. Most were male (96%), aged 18-34 (55%), and resided in the south (40%). The completion rate of all initial tests increased from 3.4% to 5.1% (P <0.01) in the 7 days before index date, and 16.8% to 22.7% for all follow-up tests within 180 days after index date (P <0.01), from 2016 to 2019. Combining all study years, less than half of patients completed any individual test within 7 days before index date: 38%, 17%, 29%, 25%, 32%, 34%, for HIV, creatinine, HBV, HCV, chlamydia/gonorrhea, and syphilis testing, respectively. Higher monitoring rates were observed in the 180 days after index date: 62%, 36%, 52%, and 54%, for HIV, creatinine, chlamydia/gonorrhea, and syphilis testing, respectively.
Younger age [13-17 years: OR=0.43; 95% CI: 0.26-0.69] vs. ≥45 year], female [OR=0.63; 0.54-0.75] vs male, no STI history [OR=0.83; 0.75-0.92], and residing in the West [OR=0.88; 0.80-0.97] or North Central [OR=0.87; 0.78-0.96] vs Northeast were associated with significantly lower likelihood of getting a HIV test within 180 days after the index date.

Conclusions: Although screening and monitoring testing rates increased over the study period, the testing was less frequent than recommended by the CDC. Our studies suggest that public health efforts, such as the education of patients and clinicians on the importance of these screening and monitoring tests, are needed to ensure the health and safety of PrEP users.