Pre-Exposure Prophylaxis Access Multifaceted; Unmet Needs Remain

Pre-Exposure Prophylaxis Access Multifaceted; Unmet Needs Remain

AT A GLANCE

• Pre-exposure prophylaxis (PrEP) is a key strategy in HIV prevention, but Black, Hispanic and Medicaid-insured populations face higher unmet needs for PrEP despite increased use from 2019 to 2023.
• Males vulnerable to acquiring HIV living in predominantly White neighborhoods have high access to PrEP and low unmet needs.
• Individuals living in predominantly Black and Hispanic neighborhoods or insured by Medicaid saw moderate increases in PrEP use and high unmet needs.
• Needs-focused solutions, including legislation and community-based interventions, are crucial to reducing disparities and improving critical access to and uptake of resources to prevent HIV.

Black, Hispanic and Medicaid-insured populations continue to lack equitable access to pre-exposure prophylaxis, according to new findings from Gilead Sciences presented at IDWeek 2024.

Several populations face economic, geographic and racial barriers to accessing PrEP. The majority of new PrEP users from 2019 to 2023 were males vulnerable to acquiring HIV who are commercially insured and live in predominantly White neighborhoods (53% in 2019 and 43% in 2023). Comparatively, males living in predominantly Black or Hispanic neighborhoods, or who are insured by Medicaid, saw lower proportions of PrEP use (16% in 2019 and 17% in 2023) despite higher annual increases in PrEP use (11% per year) and higher unmet needs.

Researchers analyzed PrEP use and HIV diagnoses from 2019 to 2023 along with demographics including sex, insurance type and neighborhood race/ethnicities, as well as other factors that may contribute to acquiring HIV. These data were used to determine PrEP-to-need ratios, defined as the number of individuals using PrEP each year divided by the number of new HIV diagnoses the previous year for five subpopulations.

The study concluded that while each group saw increases in PrEP use from 2019 to 2023, those with the highest unmet needs still lacked access due to multiple factors, including barriers to adherence and persistence.

"While strides have been made in HIV prevention, these findings underscore the need for targeted efforts, especially within communities with the highest unmet needs, to promote PrEP use," said Li Tao, MD, PhD, director of real-world evidence and epidemiology at Gilead Sciences and presenting author. "Policy and community-based care efforts are crucial next steps to making PrEP available for individuals who need or want PrEP."

Researchers say the findings spotlight PrEP as an important strategy in HIV prevention and the increasing need to address economic, geographic and racial disparities in its access and uptake.

In addition to Dr. Tao, study co-authors include: Juan Yang, PhD; Joshua Gruber, PhD; Chris Nguyen, PharmD; and Woodie Zachry, RPh, PhD.

About IDWeek
IDWeek is the joint annual meeting of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists. IDWeek is a recognized forum for peer-reviewed presentations of new research on scientific advances and bench-to-bedside approaches in prevention, diagnosis, treatment and epidemiology of infectious diseases, including HIV, across the lifespan. For more information, visit idweek.org.

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