Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015–2016
Autoři:
Stephanie S. Chan aff001; Andre R. Chappel aff001; Karen E. Joynt Maddox aff002; Karen W. Hoover aff003; Ya-lin A. Huang aff003; Weiming Zhu aff003; Stacy M. Cohen aff004; Pamela W. Klein aff004; Nancy De Lew aff001
Působiště autorů:
US Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy, Washington, DC, United States of America
aff001; Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
aff002; HHS, Centers for Disease Control and Prevention, Division of HV/AIDS Prevention, Epidemiology Branch, Atlanta, Georgia, United States of America
aff003; HHS, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
aff004
Vyšlo v časopise:
Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015–2016. PLoS Med 17(4): e1003072. doi:10.1371/journal.pmed.1003072
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pmed.1003072
Souhrn
Background
In 2015, there were approximately 40,000 new HIV diagnoses in the United States. Pre-exposure prophylaxis (PrEP) is an effective strategy that reduces the risk of HIV acquisition; however, uptake among those who can benefit from it has lagged. In this study, we 1) compared the characteristics of patients who were prescribed PrEP with individuals newly diagnosed with HIV infection, 2) identified the specialties of practitioners prescribing PrEP, 3) identified metropolitan statistical areas (MSAs) within the US where there is relatively low uptake of PrEP, and 4) reported median amounts paid by patients and third-party payors for PrEP.
Methods and findings
We analyzed prescription drug claims for individuals prescribed PrEP in the Integrated Dataverse (IDV) from Symphony Health for the period of September 2015 to August 2016 to describe PrEP patients, prescribers, relative uptake, and payment methods in the US. Data were available for 75,839 individuals prescribed PrEP, and findings were extrapolated to approximately 101,000 individuals, which is less than 10% of the 1.1 million adults for whom PrEP was indicated. Compared to individuals with newly diagnosed HIV infection, PrEP patients were more likely to be non-Hispanic white (45% versus 26.2%), older (25% versus 19% at ages 35–44), male (94% versus 81%), and not reside in the South (30% versus 52% reside in the South).Using a ratio of the number of PrEP patients within an MSA to the number of newly diagnosed individuals with HIV infection, we found MSAs with relatively low uptake of PrEP were concentrated in the South. Of the approximately 24,000 providers who prescribed PrEP, two-thirds reported primary care as their specialty. Compared to the types of payment methods that people living with diagnosed HIV (PLWH) used to pay for their antiretroviral treatment in 2015 to 2016 reported in the Centers for Disease Control and Prevention (CDC) HIV Surveillance Special Report, PrEP patients were more likely to have used commercial health insurance (80% versus 35%) and less likely to have used public healthcare coverage or a publicly sponsored assistance program to pay for PrEP (12% versus 45% for Medicaid). Third-party payors covered 95% of the costs of PrEP. Overall, we estimated the median annual per patient out-of-pocket spending on PrEP was approximately US$72. Limitations of this study include missing information on prescription claims of patients not included in the database, and for those included, some patients were missing information on patient diagnosis, race/ethnicity, educational attainment, and income (34%–36%).
Conclusions
Our findings indicate that in 2015–2016, many individuals in the US who could benefit from being on PrEP were not receiving this HIV prevention medication, and those prescribed PrEP had a significantly different distribution of characteristics from the broader population that is at risk for acquiring HIV. PrEP patients were more likely to pay for PrEP using commercial or private insurance, whereas PLWH were more likely to pay for their antiretroviral treatment using publicly sponsored programs. Addressing the affordability of PrEP and otherwise promoting its use among those with indications for PrEP represents an important opportunity to help end the HIV epidemic.
Klíčová slova:
Health economics – Health insurance – HIV – HIV diagnosis and management – HIV infections – HIV prevention – Insurance – Pre-exposure prophylaxis
Zdroje
1. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010–2015. HIV Surveillance Supplemental Report 2018; 23 (No. 1). March 2018 [cited 2018 Oct 16]. Available from: http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html.
2. Centers for Disease Control and Prevention (CDC). HIV Surveillance Report, 2016; vol. 28. November 2018 [cited 2019 Apr 1]. Available from: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2016-vol-28.pdf.
3. Centers for Disease Control and Prevention. US Public Health Service Preexposure prophylaxis for the prevention of HIV infection in the United States-2017 Update. A clinical practice guideline. 2018 March [cited 2019 Apr 1]. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf
4. Tuller D. HIV Prevention Drug’s Slow Uptake Undercuts Its Early Promise. Health Affairs. 2018;37(2):178–180. doi: 10.1377/hlthaff.2017.1650 29401032
5. US White House. Budget of the United States Government, Fiscal Year 2020. March 11, 2019 [cited 2019 Apr 1]. Available from: https://www.whitehouse.gov/wp-content/uploads/2019/03/budget-fy2020.pdf.
6. US Department of Health & Human Services. Ending the HIV Epidemic: What is ‘Ending the HIV Epidemic: A Plan for America’? September 3, 2019. [cited 2019 Oct 1]. Available from: https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview
7. Health Resources and Services Administration. “Ending the HIV Epidemic by 2030.” March 2019 [cited 2019 Aug 2]. https://www.hrsa.gov/enews/past-issues/2019/march-7/ending-the-hiv-epidemic
8. Smith DK, Van Handel M, Grey J. Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015. Ann Epidemiol. 2018 Dec 1;28(12):850–7. doi: 10.1016/j.annepidem.2018.05.003 29941379
9. Mera R, McCallister S, Palmer B, Mayer G, Magnuson D, Rawlings K. FTC/TDF (Truvada) for HIV Pre-Exposure Prophylaxis (PrEP) Utilization in the United States: 2013–2015. Presented at the 21st International AIDS Conference; 2016 July 18–22; Durban, South Africa; 2016. abstract TUAX0105LB
10. Wu H, Mendoza MC, Huang YLA, Hayes T, Smith DK, Hoover KW. Uptake of HIV preexposure prophylaxis among commercially insured persons—United States, 2010–2014. Clinical Infectious Diseases. 2016;64(2):144–149. doi: 10.1093/cid/ciw701 27986691
11. Siegler AJ, Mouhanna F, Giler RM, Weiss K, Pembleton E, Guest J, et al. The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis–to-need ratio in the fourth quarter of 2017, United States. Ann Epidemiol. 2018 Dec 1;28(12):841–9. doi: 10.1016/j.annepidem.2018.06.005 29983236
12. Smith DK, Van MH, Huggins R. Estimated coverage to address financial barriers to HIV preexposure prophylaxis among persons with indications for its use, United States, 2015. JAIDS (1999). 2017 Dec;76(5):465–72.
13. Centers for Disease Control and Prevention. HIV Surveillance Report, 2015; vol. 27. November 2016 [cited 2018 Oct 1]. Available from: http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html.
14. Centers for Disease Control and Prevention. Behavioral and Clinical Characteristics of Persons with Diagnosed HIV Infection—Medical Monitoring Project, United States, 2015 Cycle (June 2015–May 2016). HIV Surveillance Special Report 20. May 2018 [cited 2018 Aug 7]. Available from: https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html.
15. Centers for Disease Control and Prevention. Diagnosed HIV Infection among Adults and Adolescents in Metropolitan Statistical Areas–United States and Puerto Rico, 2015. Vol 22, Number 1. May 2017 [cited 2019 Apr 1]. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-22-1.pdf
16. Goldstein RH, Streed CG Jr, Cahill SR. Being PrEPared—Preexposure Prophylaxis and HIV Disparities. New England Journal of Medicine. 2018 Oct 4;379(14):1293–5. doi: 10.1056/NEJMp1804306 30230965
17. Lee, J. Gilead slowly rolls out ads for Truvada for PrEP– 4 years after approval website. May 2017 [cited 2018 May 1]. Available from: http://www.mmm-online.com/campaigns/gild-truvada-hiv-marketing-tumblr-snapchat-pharma/article/654630/.
18. Soto, J. Spreading the Word About HIV Prevention for African-American Women NPR website. January 2017 [cited 2018 May 1]. Available from: https://www.npr.org/sections/health-shots/2017/01/20/508029525/spreading-the-word-about-hiv-prevention-for-african-american-women.
19. Williams, Jeremy. Florida Health to offer PrEP for free at all county health departments by the end of 2018 website. December 2017 [cited 2018 May 1]. Available from: http://www.watermarkonline.com/2017/12/13/florida-health-offer-prep-free-county-health-departments-end-2018/.
20. US Preventive Services Task Force. Final Recommendation Statement. Prevention of Human Immunodeficiency Virus (HIV) Infection: Pre-Exposure Prophylaxis. June 2019 [cited 2019 Oct 1]. Available from: https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis.
21. Chou R, Evans C, Hoverman A, Sun C, Dana T, Bougatsos C, et al. Preexposure prophylaxis for the prevention of HIV infection: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2019 Jun 11;321(22):2214–30. doi: 10.1001/jama.2019.2591 31184746
22. Centers for Disease Control and Prevention. HIV Cost-effectiveness. October 2019 [cited 2019 Oct 1]. Available from: https://www.cdc.gov/hiv/programresources/guidance/costeffectiveness/index.html.
23. Gebo KA, Fleishman JA, Conviser R, Hellinger J, Hellinger FJ, Josephs JS, et al. Contemporary costs of HIV health care in the HAART era. AIDS (London, England). 2010 Nov 13;24(17):2705.
24. Drabo EF, Hay JW, Vardavas R, Wagner ZR, Sood N. A cost-effectiveness analysis of preexposure prophylaxis for the prevention of HIV among Los Angeles County men who have sex with men. Clinical Infectious Diseases. 2016 Aug 23;63(11):1495–504. doi: 10.1093/cid/ciw578 27558571
25. Ryan B. FDA approves generic Truvada for HIV treatment and PrEP. Poz Magazine. 2017 [cited 2019 Apr 1]. Available from: https://www.poz.com/article/fda-approves-generic-truvada.
26. Fitzsimmons T. Generic HIV prevention drug coming in 2020, Gilead says. NBC News. 2019 [cited 2019 Oct 1]. Available from: https://www.nbcnews.com/feature/nbc-out/generic-hiv-prevention-drug-coming-2020-gilead-says-n1003391
27. United States Securities and Exchange Commission, Form 10-Q for the quarterly period ended March 31, 2019. 2019 [cited 2019 Oct 1]. Available from: http://investors.gilead.com/static-files/0ff8d741-b9eb-4162-bcb4-f16094d37254
28. Coleman R, Prins M. Options for affordable pre-exposure prophylaxis (PrEP) in national HIV prevention programmes in Europe. Eurosurveillance. 2017 Oct 19;22(42):17–00698.
29. Mehta SA, Silvera R, Bernstein K, Holzman RS, Aberg JA, Daskalakis DC. Awareness of post-exposure HIV prophylaxis in high-risk men who have sex with men in New York City. Sexually transmitted infections. 2011 Jun 1;87(4):344–8. doi: 10.1136/sti.2010.046284 21357600
30. Liu AY, Kittredge PV, Vittinghoff E, Raymond HF, Ahrens K, Matheson T, et al. Limited knowledge and use of HIV post-and pre-exposure prophylaxis among gay and bisexual men. JAIDS. 2008 Feb 1;47(2):241–7. 18340656
31. Mimiaga MJ, Case P, Johnson CV, Safren SA, Mayer KH. Preexposure antiretroviral prophylaxis attitudes in high-risk Boston area men who report having sex with men: limited knowledge and experience but potential for increased utilization after education. JAIDS (1999). 2009 Jan;50(1):77–83.
32. Petroll AE, Walsh JL, Owczarzak JL, McAuliffe TL, Bogart LM, Kelly JA. PrEP awareness, familiarity, comfort, and prescribing experience among US primary care providers and HIV specialists. AIDS and Behavior. 2017 May 1;21(5):1256–67. Available from: https://link.springer.com/article/10.1007/s10461-016-1625-1 27885552
33. Walsh JL, Petroll AE. Factors related to pre-exposure prophylaxis prescription by US primary care physicians. American journal of preventive medicine. 2017 Jun 1;52(6):e165. Available from: doi: 10.1016/j.amepre.2017.01.025 28363410
34. Smith DK, Mendoza MC, Stryker JE, Rose CE. PrEP awareness and attitudes in a national survey of primary care clinicians in the United States, 2009–2015. PLoS ONE. 2016 Jun 3;11(6):e0156592. doi: 10.1371/journal.pone.0156592 27258374
35. Underhill K, Morrow KM, Colleran C, Holcomb R, Calabrese SK, Operario D, et al. A qualitative study of medical mistrust, perceived discrimination, and risk behavior disclosure to clinicians by US male sex workers and other men who have sex with men: implications for biomedical HIV prevention. Journal of Urban Health. 2015 Aug 1;92(4):667–86. Available from: doi: 10.1007/s11524-015-9961-4 25930083
36. Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, Mayer KH. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS care. 2017 Nov 2;29(11):1351–8. Available from: doi: 10.1080/09540121.2017.1300633 28286983
37. Dailey AF, Hoots BE, Hall HI, Song R, Hayes D, et al. Vital Signs: Human Immunodeficiency Virus Testing and Diagnosis Delays—United States. MMWR Morbidity and mortality weekly report. Recommendations and reports. 2017;66:1300–1306. http://dx.doi.org/10.15585/mmwr.mm6647e1.
38. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR. Recommendations and reports. 2015 Jun 5;64(RR-03):1–137. 26042815
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