HIV prevention pill not reaching most Americans who need it most

A new CDC analysis suggests only a small percentage of Americans who could benefit from pre-exposure prophylaxis (PrEP), a daily pill for HIV prevention, have been prescribed it.

In the first detailed analysis by race and by risk group, CDC researchers also found while two-thirds of people who could potentially benefit from PrEP are African-American or Latino, they account for the smallest percentage of prescriptions to date.

The findings were presented at the annual Conference on Retroviruses and Opportunistic Infections in Boston. CDC’s Division of HIV/AIDS Prevention epidemiologist and medical officer, Dawn K. Smith, MD, MPH, MS, presented the information.

Results indicate that in 2015, approximately 500,000 African-Americans and nearly 300,000 Latinos across the nation could have potentially benefited from PrEP based on CDC clinical guidelines. However, only 7,000 prescriptions were filled at retail pharmacies or mail order services for African-Americans and only 7,600 for Latinos.

The gap between how many people could potentially benefit from PrEP and how many received it was smaller among Caucasian people, yet still considerable. Of approximately 300,000 Caucasian people who could potentially have benefited from PrEP, only 42,000 prescriptions were filled at retail pharmacies or mail order services.

“One of our most powerful tools for HIV prevention remains largely on pharmacy shelves,” said Jonathan Mermin, MD, MPH, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “PrEP can be a potent prescription that strengthens prevention options for people who are at high risk for HIV infection.”

The Food and Drug Administration approved PrEP for HIV prevention in 2012. With daily PrEP dosing as directed, it can reduce the risk of sexually acquiring HIV by more than 90 percent and the risk of HIV infection among people who inject drugs by more than 70 percent.

To help direct provider and public education efforts, CDC researchers developed a new method for estimating where PrEP need is greatest. The analysis combines data on risk behavior with the latest information on HIV diagnoses nationally and in states.

“We know that in addition to risk behavior, the prevalence of HIV in communities plays an important role in a person’s likelihood of infection,” explained Smith. “We now have a powerful picture of where PrEP’s potential impact could be greatest.”

The new national estimate is that about 1.1 million Americans overall are at substantial risk for HIV and should be offered PrEP. However, only 90,000 PrEP prescriptions were filled in commercial pharmacies in the year examined.

Actual PrEP use is somewhat higher than these estimates because some Americans obtain PrEP through demonstration projects or non-commercial pharmacies, including military health plans or managed care groups that operate independent prescription drug programs. Previous studies suggest that commercial pharmacies account for roughly 85 to 90 percent of all PrEP prescriptions.

The CDC is exploring different methods to maximize PrEP use and other prevention strategies.

“Closing gaps is an important step for PrEP,” said Eugene McCray, MD, director of CDC’s Division of HIV/AIDS Prevention. “CDC is committed to equipping providers and all people living with and at risk for HIV with the information and support needed to maximize the impact of PrEP and all proven strategies.”

The Gayly. April 5, 2018. 9:24 a.m. CST.