Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015-2016.
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 characteris...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2020-04-01
|
| Series: | PLoS Medicine |
| Online Access: | https://doi.org/10.1371/journal.pmed.1003072 |
| _version_ | 1819044407036346368 |
|---|---|
| author | Stephanie S Chan Andre R Chappel Karen E Joynt Maddox Karen W Hoover Ya-Lin A Huang Weiming Zhu Stacy M Cohen Pamela W Klein Nancy De Lew |
| author_facet | Stephanie S Chan Andre R Chappel Karen E Joynt Maddox Karen W Hoover Ya-Lin A Huang Weiming Zhu Stacy M Cohen Pamela W Klein Nancy De Lew |
| author_sort | Stephanie S Chan |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-21T10:12:11Z |
| format | Article |
| id | doaj.art-ec11971d55624da8bbb49313fb8060bd |
| institution | Directory Open Access Journal |
| issn | 1549-1277 1549-1676 |
| language | English |
| last_indexed | 2024-12-21T10:12:11Z |
| publishDate | 2020-04-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Medicine |
| spelling | doaj.art-ec11971d55624da8bbb49313fb8060bd2022-12-21T19:07:41ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762020-04-01174e100307210.1371/journal.pmed.1003072Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015-2016.Stephanie S ChanAndre R ChappelKaren E Joynt MaddoxKaren W HooverYa-Lin A HuangWeiming ZhuStacy M CohenPamela W KleinNancy De LewBACKGROUND: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.https://doi.org/10.1371/journal.pmed.1003072 |
| spellingShingle | Stephanie S Chan Andre R Chappel Karen E Joynt Maddox Karen W Hoover Ya-Lin A Huang Weiming Zhu Stacy M Cohen Pamela W Klein Nancy De Lew 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 Medicine |
| title | Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015-2016. |
| title_full | Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015-2016. |
| title_fullStr | Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015-2016. |
| title_full_unstemmed | Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015-2016. |
| title_short | Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015-2016. |
| title_sort | pre exposure prophylaxis for preventing acquisition of hiv a cross sectional study of patients prescribers uptake and spending in the united states 2015 2016 |
| url | https://doi.org/10.1371/journal.pmed.1003072 |
| work_keys_str_mv | AT stephanieschan preexposureprophylaxisforpreventingacquisitionofhivacrosssectionalstudyofpatientsprescribersuptakeandspendingintheunitedstates20152016 AT andrerchappel preexposureprophylaxisforpreventingacquisitionofhivacrosssectionalstudyofpatientsprescribersuptakeandspendingintheunitedstates20152016 AT karenejoyntmaddox preexposureprophylaxisforpreventingacquisitionofhivacrosssectionalstudyofpatientsprescribersuptakeandspendingintheunitedstates20152016 AT karenwhoover preexposureprophylaxisforpreventingacquisitionofhivacrosssectionalstudyofpatientsprescribersuptakeandspendingintheunitedstates20152016 AT yalinahuang preexposureprophylaxisforpreventingacquisitionofhivacrosssectionalstudyofpatientsprescribersuptakeandspendingintheunitedstates20152016 AT weimingzhu preexposureprophylaxisforpreventingacquisitionofhivacrosssectionalstudyofpatientsprescribersuptakeandspendingintheunitedstates20152016 AT stacymcohen preexposureprophylaxisforpreventingacquisitionofhivacrosssectionalstudyofpatientsprescribersuptakeandspendingintheunitedstates20152016 AT pamelawklein preexposureprophylaxisforpreventingacquisitionofhivacrosssectionalstudyofpatientsprescribersuptakeandspendingintheunitedstates20152016 AT nancydelew preexposureprophylaxisforpreventingacquisitionofhivacrosssectionalstudyofpatientsprescribersuptakeandspendingintheunitedstates20152016 |