Disparities Exist in Use of PrEP to Prevent HIV | ID Week 2024

Access to and initiation of pre-exposure prophylaxis (PrEP) to prevent HIV infection is lacking in diverse populations and for those on Medicaid, according to results of a new analysis presented at ID Week 2024, which is being held this week in Los Angeles.

Li Tao, M.D., Ph.D.

“We know PrEP is a very important strategy for HIV prevention, and there are many options right now on the market. And although PrEP uptake has been increasing throughout the years, disparities still persist in uptake and initiation across diverse population groups,” Li Tao, M.D., Ph.D., director of Real-World Evidence at Gilead Sciences, said during a press conference ahead of the meeting.

Tao and her colleagues wanted to identify priority populations with unmet needs in a real-world setting. They obtained data on PrEP prescriptions and new HIV-1 diagnoses from 2019 to 2023 from an IQVIA claims database, which is a large database with more than half a million real-world PrEP users.

Researchers assessed a PrEP-to-need ratio (PNR), which includes the number of people using PrEP in a year divided by new HIV diagnoses in the previous year. This was calculated for subpopulations defined by five factors: sex, insurance, recorded HIV-1 risk factors, the jurisdictions from the Ending the HIV Epidemic initiative, and neighborhood race/ethnicity composition. In this analysis, a lower PrEP-to-need ratio indicates higher unmet need. The Ending the HIV Epidemic initiative is an effort that began in 2019 with a goal of reducing new HIV infections by 90% by 2030.

What Tao and her colleagues found was that a large proportion of newly initiated PrEP users in both 2019 (53% of 93,344) and 2023 (43% of 125,819) were men with HIV-1 risk factors, using commercial insurance, and residing in White dominant neighborhoods.

Other men with HIV-1 risk factors, including those commercially insured residing in Black/Hispanic neighborhoods or those on Medicaid across all neighborhoods, had a moderate increase in PrEP initiation and higher unmet needs.

Men and women without recorded HIV-1 risk factors showed the highest PrEP initiation increase but also had the most substantial unmet needs from 2019 to 2023. Researchers said those on Medicaid or residing in Black/Hispanic communities would benefit from increased PrEP uptake to address disparities in HIV prevention.

“Disparities still persist, and the need remains very significant,” Tao said. “Identifying the priority populations for PrEP is crucial for guiding the future HIV prevention options.”

Gilead markets several PrEP medications, including: Truvada (emtricitabine/tenofovir disoproxil fumarate) and Descovy (emtricitabine/tenofovir alafenamide). The company also markets Sunlenca (lenacapavir), a long-acting antiretroviral medication to treat people with HIV. Lenacapavir is currently in development to prevent HIV infection. Last month, the company announced results of a second phase 3 clinical trial that showed 99.9% of the 2,180 total participants treated with lenacapavir did not acquire HIV.