PrEP uptake remains low among those who need it most

New data presented at IDWeek 2021 shows a lack of use of pre-exposure prophylaxis (PrEP) among groups at high risk of HIV infection.

Although the preventive efficacy of pre-exposure prophylaxis (PrEP) against HIV is well known and there are 2 formulations available on the US market: Truvada (emtricitabine / tenofovir disoproxil fumarate [FTC/TDF]) and Descovy (emtricitabine / tenofovir alafenamide [FTC/TAF]) – those who could benefit the most from PrEP start a diet in small numbers.

New data presented at IDWeek 2021 shows that young adults, women, heterosexuals, and Black / African Americans, all of whom are considered high-risk groups, take a long time to start treatment with PrEP, especially FTC / TDF. For this analysis, PrEP users were defined as having at least 1 FTC / TDF prescription within 12 months of their index date.

“There is a need to better understand the characteristics of high-risk people who use PrEP compared to those who do not use PrEP in the real world,” the authors wrote.

Data for the 2012-2018 study years were provided via interviews with HIV healthcare providers, a medical coder (to understand the use of codes that signify high-risk behavior or rectal bacterial infection by syphilis, chlamydia, or gonorrhea), IBM Commercial Dating and Complaints Database, and IBM Multi-State Medicaid Database. Each participant’s study index date was the first in a claim with high-risk sexual behavior code, rectal sexually transmitted bacterial infection [STI] or a second non-rectal bacterial STI within 12 months.

Results show that people with commercial insurance who initiated PrEP within 12 months of their indexation date tended to be older than non-PrEP users (mean [SD] age, 36.7 [11.1] against 29.6 [12.1] years), male (98.6% against 37.1%) and homosexual (46.6% against 1.5%). People covered by Medicaid who started PrEP were more likely to be older than non-PrEP users (31.8 [11.6] and 25.2 [11.0] years, respectively), but still younger than those with commercial coverage, and men (77.1% vs. 22.0%); a majority of PrEP users and non-users in the Medicaid group were heterosexual (68.4% and 49.8%, respectively).

For study years, analyzed by age and insurance status, PrEP uptake increased steadily among people aged 16 to 24, 25 to 34, and 35 and over in 2012 to 2017 (0.03% to 2.46%, 0.18% to 10.28% and 0.14% to 13.23%, respectively) before declining slightly in 2018 (to 2.26%, 9, 62% and 13.03%). Utilization among commercially insured women remained low during this same period, never exceeding 0.16%, while among men it fell from 0.22% to 16.53%.

There was much less variation in PrEP uptake among those with Medicaid coverage, with none of the age groups increasing above 1.0% and only men seeing a large increase in adoption, from 0.04% to 1.99% against 0.0% to 0.13% for women. .

Overall, at the end of the study, these results were observed:

  • Having Medicaid coverage resulted in an overall decline in PrEP uptake (0.53%) compared to commercial insurance (7.30%).
  • Women at high risk lag behind in their absorption of PrEP compared to men.
  • The youngest age group (16-24 years) had the lowest PrEP gains compared to the oldest age group (≥35 years).
  • More PrEP non-users were women and Black / African Americans.
  • More PrEP users have been classified as gay or bisexual.
  • PrEP users had higher scores on the Charlson Comorbidity Index and were more likely to have full insurance coverage.

Due to sample size restrictions (only Medicaid and commercially insured claims were analyzed), the possibility of erroneous coding of high risk behaviors, inability to account for market entry generic FTC / TDF in September 2020 and the results related to FTC / TAF not being studied, the authors’ results may not be generalizable to a larger patient population.

However, the results underscore the importance of increasing the availability and access to PrEP among those who need it most.

“This information will help health workers identify populations with unmet PrEP needs and ultimately target efforts to reduce new HIV infections,” they concluded.


Zhou M, Song Y, Gao E, Whiteside Y, Billmyer E, Signorovitch J. Prescriptions of pre-exposure prophylaxis (PrEP) in people at high risk of HIV in the United States, 2012-2018. Presented at: IDWeek 2021; September 29-October 3, 2021; virtual. Poster 75. Accessed October 14, 2021.

About Bradley J. Bridges

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