Background Providers face challenges identifying patients to benefit from PrEP, while disparities remain in PrEP access. We examine gaps in identification of PrEP candidates, uptake, and use of PrEP by populations at high HIV risk within a large federally qualified health center with a lesbian/gay/bisexual/transgender/queer (LGBTQ) focus.
Methods An established PrEP:Need ratio was calculated to examine differences in PrEP use across race, age, gender, and insurance. Two new measures were developed to determine gaps in identifying candidates and uptake - Identification:Need and PrEP:Identification. Patients were identified through electronic health records who had a documented indication for PrEP according to CDC guidelines, whether patients had a PrEP prescription, and if they seroconverted, from 2015–2018.
Results Over 50,000 unique patients were included, with median age 30.5; patients were 48% White, 47% men who have sex with men (MSM), and 7% transwomen. Overall, there were 14.6 patients on PrEP for each incident HIV infection (PrEP:Need). PrEP:Need was 24.5 among White patients, compared to 6.6 among Black patients. PrEP:Need was low for Medicaid/Medicare patients (7.9), transwomen (10.0), and particularly Black transwomen (4.6). Low PrEP:Need ratios were usually driven by low Identification:Need ratios, with large differences: among MSM, 23.2 patients were indicated for PrEP per incident infection compared to 7.2 among transwomen. Uptake, measured by PrEP:Identification ratios, were lowest among patients without insurance and highest among those with private insurance.
Conclusion We found high variation in PrEP:Need ratios across race, gender, and insurance status. This may be due to a poor fit between current PrEP indications and actual HIV incidence in key populations; there may also be gaps in patient-provider communication and documentation of PrEP indications in certain populations. We also found evidence of barriers to uptake, particularly related to insurance status. We will discuss ways to improve PrEP detection and uptake, which attendees can apply to their practice.
Disclosure No significant relationships.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.