PrEP Delivery Remains Low Among Those With Opioid/Stimulant Use Disorder

HIV preexposure prophylaxis (PrEP) delivery remained low among commercially insured individuals with opioid and/or stimulant use disorder (SUD), including those with evidence of injection drug use (IDU), according to the results of a study published in JAMA Network Open.

PrEP should be consistently offered alongside HIV prevention services, substance use disorder treatment, and other harm reduction services, investigators said.

The study’s cohort included 211,609 women and 336,100 men, with a combined mean age of 34.8 years. Of these, 110,592 individuals had evidence of IDU.

During the study period, 508 individuals with opioid and/or SUD received PrEP, including 170 with evidence of IDU.

Investigators found that the receipt of PrEP increased from 0.001 to 0.243 per 100 person-years from 2010 through 2019 or the entire cohort. The number jumped from 0.000 to 0.295 per 100 person-years among those with IDU during the same period.

In the analysis, investigators found the PrEP use was more likely among males, individuals with evidence of IDU, and those with evidence of sexual risk indications for PrEP.

Investigators used deidentified data from the Market Scan Commercial Claims and Encounters Database to identify individuals who were commercially insured. They included 547,709 individuals without HIV but with opioid and/or SUD, including 110,592 with evidence of IDU between January 1, 2010, and December 31, 2019.

Investigators included individuals aged 16 years or older with OUD, those with SUD, or co-occurring opioid and SUD. Individuals were followed for as long as they were in the data set at any time or until the end of the study period.

MarketScan includes ambulatory and inpatient visits, diagnostic and laboratory testing, and outpatient pharmacy claims.

Investigators analyzed the data from November 1, 2020, to July 1, 2021.

They identified individuals with opioid and/or SUD and evidence of IDU through claims data.

The outcome of the study was receipt of tenofovir disoproxil fumarate and emtricitabine for PrEP. Multivariable logistic regression was used to assess the associations of clinical characteristics and demographics.

However, the study did have some limitations. First, all data were from individuals with a PrEP prescription that was billed to the commercial insurer. Therefore, investigators were not able to see other prescriptions that were funded through other sources, such as cash or research studies.

Additionally, investigators the data likely under identify individuals with SUD and those with evidence of IDU, because it relies on billing claims through clinical conditions, not explicitly identifying those with evidence of IDU, investigators said.

To achieve the public health goal of reducing new HIV infections by 75% by 2025 and by 90% by 2030, no evidence-based prevention strategies can be overlooked, investigators said.

The rate of PrEP among those who were commercially insured and those with evidence of IDU as well as those with substance use disorder remains low, investigators said.

Reference

Streed CG, Morgan JR, Gai MJ, Larochelle MR, Paasche-Orlow MK, Taylor JL. Prevalence of HIV preexposure prophylaxis prescribing among persons with commercial insurance and likely injection drug use. JAMA Netw Open. 2022;5(7):e2221346. doi:10.1001/jamanetworkopen.2022.21346