(118) Disparities and Changes in PReP Coverage for HIV Prevention Before and During The COVID-19 Pandemic in the U.S.

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1163

Presenting Author(s)

Mahdi Fallahi, MA, MS, PhD
– Senior Research Associate, University of Southern California-School of Pharmacy, University of Southern California, Los Angeles, California, United States

Co-Author(s)

Jenny Guadamuz
– Jenny Guadamuz, New York, New York, United States
Carter McCormick
– University of Illinois at Chicago, IL, United States
Dima Qato
– Los Angeles, California, United States

Background: Pre-exposure prophylaxis (PrEP) is an essential antiretroviral medication indicated for the prevention of HIV infection among high-risk populations. Despite efforts to expand access to PREP, particularly in priority jurisdictions that account for the largest HIV burden in the U.S.,

Objectives: To examine trends and disparities in PrEP coverage at the national, state and county-level between 2019 and 2020.

Methods:

Methods: We used longitudinal, individual-level pharmacy claims from IQVIA LRx to identify PrEP users and data from the CDC for total populations at high risk for HIV at the national, state and county-level by age and gender. We evaluate weekly PrEP coverage among individuals ages 16 to 85 years between November 2019 and November 2020 in the U.S. PrEP coverage was defined as the proportion of individuals at risk for HIV receiving PrEP prescriptions at retail pharmacies. We conducted an interrupted time series analysis using segmented regressions to quantify changes in weekly PrEP coverage before (November1st 2019- March 15th 2020) and during (March 16th-November 16th 2020) the pandemic. We also evaluated whether changes in weekly PrEP coverage differed across age, sex, and county characteristics, including urbanicity and racial/ethnic composition.
Population Studied: Population at risk for HIV; In 2019, 1,206,530 individuals ages 16 to 85 were at high risk for HIV in the US of which 83.2% were male.

Results: Nationally, the average weekly PrEP coverage declined from 10.6% before the pandemic to 8.6% during the pandemic (p < 0.01).The prevalence and changes in PrEP coverage varied substantially between and within states, including priority jurisdictions. Among states with a substantial HIV burden in rural areas, before the pandemic Alabama had the highest PrEP coverage (9.2%) and Oklahoma (4.8%) had the lowest. In urban priority jurisdictions, before and during the pandemic New York County had the highest weekly PrEP coverage (58.2%) and San Bernardino County, California (1.3%) had the lowest. Predominately Black urban counties experienced a significantly greater declines in PrEP coverage (17.1% to 10.1%) than predominately White counties (from 8.7% to 8.4%). There also were substantial age disparities among males with weekly PrEP coverage higher among males ≥55 years (12.9%) and lowest among males ages 16 to 24 years (4.5%).

Conclusions: In 2020, only 10% of individuals at high risk for HIV were taking PrEP and PrEP coverage varied substantially across the country, and was disproportionately low in priority jurisdictions. PrEP coverage declined throughout during the COVID-19 pandemic with the most substantial declines observed in predominately Black urban counties, exacerbating disparities in PrEP coverage that existed before the pandemic.