PrEP Not Reaching All Who Can Benefit

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Many more American adults should be receiving pre-exposure prophylaxis (PrEP) to prevent HIV infections, but many health providers do not know about its benefits, according to new information released by the CDC.

A new Vital Signs report published on November 24, 2015 estimates that 1 in 4 sexually active gay and bisexual adult men, nearly 1 in 5 adults who inject drugs, and 1 in 200 heterosexually active adults are at substantial risk for HIV infection and should be counseled about PrEP, a daily pill for HIV prevention.

“PrEP isn’t reaching many people who could benefit from it, and many providers remain unaware of its promise,” said CDC Director Tom Frieden, MD, MPH. “With about 40,000 HIV infections newly diagnosed each year in the US, we need to use all available prevention strategies.”

PrEP is one essential component of America’s prevention efforts to combat the HIV epidemic. Other strategies include treatment to suppress the virus among people living with HIV; correct and consistent use of condoms; reducing risk behaviors; and ensuring people who inject drugs have access to sterile injection equipment from a reliable source.

“PrEP has the potential to dramatically reduce new HIV infections in the nation,” says Jonathan Mermin, MD, MPH, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “However, PrEP only works if patients know about it, have access to it, and take it as prescribed.”

The CDC researchers, led by Dawn K. Smith, MD, from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, analyzed nationally representative data to estimate the percentages and numbers of people in the United States, by transmission risk group, with indications for PrEP consistent with the 2014 US Public Health Service's PrEP clinical practice guideline.

They found that approximately 24.7% of sexually active adult men who have sex with men, 18.5% of persons who inject drugs, and 0.4% of heterosexually active adults had substantial risks for acquiring HIV consistent with PrEP indications.

“Efforts to increase knowledge of and access to PrEP should accompany efforts to increase early diagnosis and treatment of persons with HIV infection to achieve the prevention benefits of viral suppression,” they stated.

A separate analysis published the same day in Vital Signs suggests that focused efforts can significantly expand the reach of PrEP. Researchers led by Franklin N. Laufer, PhD, from the Office of Medicaid Policy and Programs, AIDS Institute, New York State Department of Health, New York City, reported that PrEP use among New Yorkers covered by Medicaid increased from 303 prescriptions filled from July 1, 2013, through June 30, 2014, to 1,330 prescriptions filled from July 1, 2014, through June 30, 2015 in the year following the launch of a statewide effort to increase PrEP knowledge among potential prescribers and candidates.

They suggested that “other jurisdictions can follow New York State's example by taking similar steps to remove the financial and knowledge barriers experienced by both potential users and prescribers of PrEP.”