PrEP Prescribing Patterns Reveal Disparities in HIV Prevention Across Settings

Pre-exposure prophylaxis (PrEP) is a vital part of the recommended approach for HIV prevention, according to the World Health Organization and the CDC. PrEP involves the administration of antiretroviral medications either continuously or for identified high-risk situations and has been highly effective in HIV prevention. Compared with placebo, consistent intake of daily oral PrEP has demonstrated up to a 92% risk reduction for sexual transmission of HIV.¹

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In a study conducted at 2 academic health care institutions (institution A and institution B) in Chicago, Illinois, investigators aimed to understand practice patterns and opportunities for prescribing PrEP. They evaluated electronic medical records including visits for patients 18 years of age and older with at least 1 negative HIV test between January 1, 2015, and December 31, 2021, who had indications for PrEP.2 Patient visits were included in this study if they were with a 6-month period after sexually transmitted infection (STI) diagnosis or individuals had documented injection drug use (IDU).²

Additionally, the investigators categorized the visits as inpatient, emergency department (ED), primary care, infectious disease, obstetrics and gynecology (OBGYN), and other outpatient settings. The investigators used bivariable and multivariable mixed effects regression models to study associations, reporting odds ratios (or adjusted odds ratios) and 95% confidence intervals (OR, aOR, 95% CI).²

In all, 9644 individuals accounted for 53,031 visits that resulted in 4653 PrEP prescriptions. Importantly, the 2health care institutions differed in demographics.2 Institution A had more 18- to 24-year-olds (58.3% vs 31.3%), more Black individuals (83.8% vs 27.9%), and more women (65.7% vs 46.3%). Institution A also included more patient visits in the ED (30.8% vs 7.3%), infectious disease, inpatient, OBGYN, and primary care settings. Meanwhile, institution B had more White (40.6% vs 7.1%) and Hispanic patients (14.0% vs 4.2%), and more men who have sex with men (MSM; 15.2% vs 3.3%). Most of the PrEP prescriptions (97.0%) were from Institution B.²

Adjusted models determined lower odds of PrEP prescriptions in non-Hispanic Black and Latino patients, those with an intrauterine device contraceptive, MSM, and in the ED or OBGYN settings. Increased odds of PrEP prescription were associated with non-Hispanic White and MSM patients, as well as visits at institution B and in infectious disease, primary care, and other outpatient subspecialty settings.²

At the study’s conclusion, the investigators noted that patients at institution A were historically underrepresented in PrEP prescriptions and most PrEP prescriptions came from Institution B, signaling the need for improved equality in PrEP prescribing across various institutions and settings.

References

1. Sundareshan V, Swinkels HM, Nguyen AD, Mangat R, Koirala J. Preexposure Prophylaxis for HIV Prevention. In: StatPearls. Treasure Island (FL): StatPearls Publishing; January 28, 2024.

2. McNulty MC, McGuckin K, Friedman EE, et al. Understanding Opportunities for Prescribing Pre-exposure Prophylaxis (PrEP) at Two Academic Medical Centers in a High Priority Jurisdiction for Ending the HIV Epidemic. Preprint. medRxiv. 2024;2024.07.25.24310992. Published 2024 Jul 26. doi:10.1101/2024.07.25.24310992