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Sullivan PS, DuBose SN, Castel AD, Hoover KW, Juhasz M, Guest JL, Le G, Whitby S, Siegler AJ. Equity of PrEP uptake by race, ethnicity, sex and region in the United States in the first decade of PrEP: a population-based analysis. LANCET REGIONAL HEALTH. AMERICAS 2024; 33:100738. [PMID: 38659491 PMCID: PMC11041841 DOI: 10.1016/j.lana.2024.100738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
Background PrEP was approved for HIV prevention in the US in 2012; uptake has been slow. We describe relative equity with the PrEP Equity Ratio (PER), a ratio of PrEP-to-Need Ratios (PnRs). Methods We used commercial pharmacy data to enumerate PrEP users by race and ethnicity, sex, and US Census region from 2012 to 2021. We report annual race and ethnicity-, sex-, and region-specific rates of PrEP use and PnR, a metric of PrEP equity, to assess trends. Findings PrEP use increased for Black, Hispanic and White Americans from 2012 to 2021. By 2021, the rate of PrEP use per population was similar in Black and White populations but slightly lower among Hispanic populations. PnR increased from 2012 to 2021 for all races and ethnicities and regions; levels of PrEP use were inconsistent across regions and highly inequitable by race, ethnicity, and sex. In all regions, PnR was highest for White and lowest for Black people. Inequity in PrEP use by race and ethnicity, as measured by the PER, grew early after availability of PrEP and persisted at a level substantially below equitable PrEP use. Interpretation From 2012 to 2021, PrEP use increased among Americans, but PrEP equity for Black and Hispanic Americans decreased. The US South lagged all regions in equitable PrEP use. Improved equity in PrEP use will be not only just, but also impactful on the US HIV epidemic; persons most at-risk of acquiring HIV should have the highest levels of access to PrEP. Prevention programs should be guided by PrEP equity, not PrEP equality. Funding National Institutes of Health, Gilead Sciences.
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Affiliation(s)
| | | | - Amanda D. Castel
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Karen W. Hoover
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jodie L. Guest
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gordon Le
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shamaya Whitby
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron J. Siegler
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Guo Y, Westmoreland DA, D'Angelo A, Mirzayi C, Dearolf M, Carneiro PB, Ray M, Pantalone DW, Carrico AW, Patel VV, Golub SA, Hirshfield S, Hoover D, Nash D, Grov C. PrEP Discontinuation In A US National Cohort Of Sexual And Gender Minority Populations, 2017-22. Health Aff (Millwood) 2024; 43:443-451. [PMID: 38437609 DOI: 10.1377/hlthaff.2023.00867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
In the US, sexual and gender minority populations are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a key prevention method, but its effectiveness relies on consistent usage. Our four-year national cohort study explored PrEP discontinuation among sexual and gender minority people who initiated PrEP. We found a high annual rate of discontinuation (35-40 percent) after PrEP initiation. Multivariable analysis with 6,410 person-years identified housing instability and prior history of PrEP discontinuation as predictors of discontinuation. Conversely, older age, clinical indication for PrEP, and having health insurance were associated with ongoing PrEP use. To promote sustained PrEP use, strategies should focus on supporting those at high risk for discontinuation, such as younger people, those without stable housing or health insurance, and prior PrEP discontinuers.
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Affiliation(s)
- Yan Guo
- Yan Guo, City University of New York, New York, New York
| | | | | | | | | | | | - Meredith Ray
- Meredith Ray, University of Memphis, Memphis, Tennessee
| | - David W Pantalone
- David W. Pantalone, University of Massachusetts Boston, Boston, Massachusetts
| | - Adam W Carrico
- Adam W. Carrico, Florida International University, Miami, Florida
| | - Viraj V Patel
- Viraj V. Patel, Albert Einstein College of Medicine, New York, New York
| | | | - Sabina Hirshfield
- Sabina Hirshfield, SUNY Downstate Health Sciences University, New York, New York
| | - Donald Hoover
- Donald Hoover, Rutgers University, New Brunswick, New Jersey
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Schnarrs PW, Zuñiga J, Benitez G, Fliedner P, Norwood A, Croll M, Oviedo LDS, Buchorn J, Oeffinger J, Lane R, Schelling E, Pham G, Pate T, Arnold EM. Intention to Use Different Formulations of Longer Acting HIV Pre-Exposure Prophylaxis Among Transgender and Gender Expansive Individuals: The Roles of Social Vulnerability and Medical Mistrust. AIDS Patient Care STDS 2024; 38:51-60. [PMID: 38381948 DOI: 10.1089/apc.2023.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
In 2012, the Federal Drug Administration approved daily oral pre-exposure prophylaxis (PrEP) for HIV prevention in adults. Longer acting injectable PrEP (LA PrEP) has been approved and other formulations are in development. A successful LA PrEP rollout requires examining potential facilitators and barriers to PrEP uptake. Given that transgender and gender expansive (TGE) individuals experience more social vulnerability and higher levels of medical mistrust compared to other populations, examining the role of these two factors in LA PrEP uptake is important. This study, PrEP for ALL, is a community-based participatory research project in Texas that engaged TGE community members and organizational partners through a community advisory board. In total, 482 TGE individuals were recruited and responded to all relevant questions in an online survey, including their intentions to use three formulations: a monthly oral pill, a bimonthly intramuscular injection, and an annual subdermal implant. Multiple regression analysis was used to examine the influence of social vulnerability and medical mistrust on intention to use each LA PrEP formulation adjusting for other relevant factors. Findings suggest that individuals with higher levels of social vulnerability had greater intentions to use the monthly oral pill (β = 0.12, p = 0.009), the bimonthly intramuscular injection (β = 0.18, p < 0.001), and annual subdermal implant (β = 0.17, p < 0.001), whereas medical mistrust reduced intentions to use the bimonthly intramuscular injection (β = -0.18, p < 0.001) and annual subdermal implant (β = -0.11, p = 0.021). Improvements in gender-affirming clinical care are needed along with LA PrEP formulations that allow for greater autonomy and reduced clinical contact. Clinical Trial Registration number: NCT05044286.
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Affiliation(s)
- Phillip W Schnarrs
- Department of Population Health, The University of Texas at Austin, Austin, Texas, USA
| | - Julie Zuñiga
- School of Nursing, The University of Texas at Austin, Austin, Texas, USA
| | - Gabrielle Benitez
- Department of Population Health, The University of Texas at Austin, Austin, Texas, USA
| | - Paul Fliedner
- Department of Population Health, The University of Texas at Austin, Austin, Texas, USA
| | - Aliza Norwood
- Department of Population Health, The University of Texas at Austin, Austin, Texas, USA
- Department of Internal Medicine, The University of Texas at Austin, Austin, Texas, USA
| | - Madeleine Croll
- Department of Sociology, The University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | | | - Jacey Buchorn
- Department of Sociology, The University of Texas at Austin, Austin, Texas, USA
| | | | - Rocky Lane
- Transgender Education Network of Texas, Austin, Texas, USA
| | | | - Gin Pham
- Transgender Education Network of Texas, Austin, Texas, USA
| | - TreShaun Pate
- Transgender Education Network of Texas, Austin, Texas, USA
| | - Elizabeth M Arnold
- Department of Psychiatry, The University of Kentucky, Lexington, Kentucky, USA
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Hellinger FJ. The Incidence, Prevalence and Mortality Rates of Black and White Persons with HIV in the United States in 2019. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01794-0. [PMID: 37697144 DOI: 10.1007/s40615-023-01794-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION This study examines the experience of non-Hispanic Black Americans (hereinafter referred to as Black persons) and non-Hispanic White Americans (hereinafter referred to as White persons) with regard to the incidence (i.e., number of persons diagnosed with HIV), prevalence (i.e., number of persons living with HIV), and mortality rates of persons with HIV in the United States in 2019. With regard to mortality rates, this study examines the mortality rate of all Black persons and White persons with HIV in 2019 as well as the mortality rate of hospitalized Black persons and White persons with HIV in 2019. METHODS Data on the racial characteristics of all persons in the United States in 2019 were obtained from the United States Census Bureau, and data on the racial characteristics of all persons with HIV in the United States were obtained from HIV Surveillance Reports produced by the Centers for Disease Control and Prevention (CDC). In addition, data on all hospital patients in seven states (California, Florida, Michigan, New Jersey, New York, South Carolina and Wisconsin) in 2019 were obtained from the Agency for Healthcare Research and Quality (AHRQ) Hospital Cost and Utilization Project (HCUP) State Inpatient Database (SID). These seven states included 44 percent of all persons living with HIV in the United States in 2019. RESULTS This study found that Black persons were more likely to be diagnosed with HIV, live with HIV, and die with HIV than White persons in the United States. This is illustrated by the fact that in 2019 Black persons comprised 13.4 percent of the population, yet they comprised 42.1 percent of persons diagnosed with HIV, 40.4 percent of persons living with HIV, and 42.9 percent of persons who died with HIV. By comparison, in 2019 White persons comprised 76.3 percent of the population, yet they comprised 24.8 percent of persons diagnosed with HIV, 29.1 percent of persons living with HIV, and 31.8 percent of persons who died with HIV. Nevertheless, this study did not find a statistically significant difference between the in-hospital mortality rates of Black and White persons in seven states in 2019. CONCLUSIONS The burden of HIV was considerably greater on Black persons than White persons in the United States in 2019.
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Affiliation(s)
- Fred J Hellinger
- Agency for Healthcare Research and Quality (AHRQ), United States Department of Health and Human Services, 5600 Fishers Lane, Rockville, Maryland, 20857, USA.
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Meanley S, Egan JE, Ware D, Brennan-Ing M, Haberlen SA, Detels R, Palella F, Friedman MR, Plankey MW. Self-Reported Combination HIV Prevention Strategies Enacted by a Prospective Cohort of Midlife and Older Men Who Have Sex with Men in the United States: A Latent Class Analysis. AIDS Patient Care STDS 2022; 36:462-473. [PMID: 36394465 PMCID: PMC9839341 DOI: 10.1089/apc.2022.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Insights into combination HIV prevention (CHP) strategies to reduce HIV incidence among midlife and older adult men who have sex with men (MSM) are limited. The current study is a secondary data analysis evaluating CHP in a sample of sexually active midlife and older adult MSM (N = 566) from the Multicenter AIDS Cohort Study Healthy Aging Substudy. Stratified by HIV serostatus, we used latent class analyses to identify CHP classes based on self-reported sociobehavioral and biobehavioral prevention strategies that participants and their male partners used in the prior 6 months. We identified three CHP classes among men living without HIV (MLWOH), including the following: high CHP overall (43.0%), high anal sex abstention (15.0%), and low prevention overall (42.0%). Among men living with HIV (MLWH), we identified four CHP classes, including the following: high CHP overall (20.9%), high CHP/low condom use (27.1%), high condom reliance (22.3%), and low prevention overall (29.7%). There were small differences by sociodemographic characteristics and sexual behavior practices between the classes; however, poppers use was often linked to being in high CHP groups. Our findings support that CHP is not one-size-fits-all for midlife and older adult MSM. There remains a need to scale up clinical providers' sexual health communication practices to assist midlife and older MSM incorporate prevention strategies, particularly biobehavioral prevention strategies that align with their patients' lived experiences.
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Affiliation(s)
- Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - James E. Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Deanna Ware
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York City, New York, USA
| | - Sabina A. Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Roger Detels
- Department of Epidemiology and Infectious Diseases, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - Frank Palella
- Department of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mackey R. Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Michael W. Plankey
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA
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