The US Food and Drug Administration
(tenofovir/emtricitabine) for HIV prevention in July 2012. It has been
difficult to estimate the total number of people using PrEP because this
information is not centrally collected.
For the past several years Gilead Sciences, the maker of Truvada, has been reporting PrEP use
estimates based on surveys of commercial pharmacies. At the International AIDS Society Conference on HIV Science last summer, Gilead researchers reported that an estimated 120,000 people had ever started Truvada for PrEP since 2012.
Now, Gilead has teamed up with researchers at Emory University's Rollins
School of Public Health to make the latest PrEP numbers available via AIDSVu, an interactive online
map of the US HIV/AIDS epidemic.
The new figures presented in AIDSVu show the number of individuals
who were prescribed Truvada for HIV
prevention during 2016. Anonymous
data were obtained from Source Healthcare Analytics (SHA) and compiled by Emory
researchers led by AIDSVu principal scientist Patrick Sullivan.
SHA collects data from more than 54,000 pharmacies, 1500 hospitals, 800
outpatient facilities and 80,000 physician practices across the US. It includes
prescriptions paid for in cash or by private insurance, Medicaid or Medicare
(programmes for low-income people and seniors, respectively) or patient
assistance programmes. It does not include PrEP obtained from other sources
including demonstration studies, military and veterans' health systems and
managed care providers that run their own pharmacies (such as Kaiser Permanente).
The CDC estimates that 85 to 90% of PrEP prescriptions are filled at commercial
The data released this week indicate that a total of 77,120 people were
using PrEP in 2016, up from 8768 in 2012. This represents a 73% average annual
increase, or a cumulative increase of 877% over the entire four-year period.
But behind these overall numbers lie some notable demographic and geographic
Men accounted for 93% of PrEP users in 2016. Although
women account for about 19% of all new HIV diagnoses in the US, they make up
only 7% of PrEP users. About two-thirds of PrEP users are in the 25-to-44
age range, a group that accounted for just over half of new diagnoses. While 21% of new diagnoses are in people under the age of 25, only 11%
of PrEP users are in this age group.
In terms of geography, the rate of PrEP use in the Northeast region was around twice that of the West,
South or Midwest (47.4, 28.1, 22.6 and 23.5 users per 100,000 people,
respectively). Although just over half of all new HIV diagnoses occurred in
the south, this region was home to only 30% of PrEP
After adjusting for population size, New York,
Massachusetts, Rhode Island, Washington and Illinois had the highest PrEP usage
"We hope that the newly available data on AIDSVu will allow health
departments, elected officials, medical professionals
and community leaders to better understand and visualize the realities of who
has access to this important prevention tool so they can develop programs and
policies to decrease barriers," commented AIDSVu principal scientist
a poster presented at CROI, Sullivan's team looked at the distribution of PrEP
users and compared it to the need for PrEP based on where new HIV infections
are occurring. Using US census data and HIV case surveillance data from the
CDC, they calculated a "PrEP-to-need" ratio, dividing the number of
PrEP prescriptions by the number of new HIV diagnoses (both per 100,000
people). A higher ratio means better PrEP coverage for those who need it.
researchers reported that around 61,300 individuals nationwide had active
PrEP prescriptions in the second
quarter of 2017, or 23.0 per 100,000 people. (Not everyone who starts PrEP
stays on it over time, so the quarterly number is smaller than the annual total
reflected in the AIDSVu figures described above.) There were 15.0 new HIV
diagnoses per 100,000 people nationwide, giving a PrEP-to-need ratio of 1.5.
Northeast, which had the highest rate of PrEP use at 38.5 and 13.3 new HIV
diagnoses per 100,000, had the highest PrEP-to-need ratio, at 2.9. The South
had a low PrEP use rate of 18.8 and a high diagnosis rate of 20.9 per 100,000,
giving the lowest PrEP-to-need ratio, at 0.9. The Midwest and West fell in
between, with PrEP-to-need ratios of 2.1 and 1.8, respectively.
team also calculated PrEP use and PrEP-to-need ratios for various demographic groups.
Women had a PrEP usage rate of 2.0 and a new diagnosis rate of 5.5 per 100,000,
giving a PrEP-to-need ratio of 0.4, indicating great unmet need. In comparison,
men had a PrEP usage rate of 45.0 and a diagnosis rate of 24.9 per 100,000, for
a PrEP-to-need ratio of 1.8. People age 24 and younger or 55 and older had
lower PrEP-to-need ratios than those between these ages.
with a higher proportion of people living in poverty, more people without
health insurance and those that did not implement Medicaid expansion under the
Affordable Care Act – which provides coverage for more people further up the
income scale – had lower rates of PrEP usage and lower PrEP-to-need ratios.
study estimates that only 5% of the 1.2 million persons indicated for PrEP are
potentially receiving PrEP protection, demonstrating a need to scale up PrEP
among all groups and in all regions," the researchers concluded.